Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

Abstract Background Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing. Methods This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis. Results In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases. Conclusion In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

10.21203/rs.3.rs-24993/v2 ◽

2020 ◽

Author(s):

Yuxuan Lu ◽

Cidan Zhuoga ◽

Haiqiang Jin ◽

Feiqi Zhu ◽

Yuhua Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young Adult ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

High Altitude ◽

Intravenous Thrombolysis ◽

Categorical Variables ◽

Anterior Circulation ◽

Tibet Autonomous Region

Abstract Background: Lots of studies of acute ischemic stroke (AIS) had been conducted at low altitude regions, and related findings were used to instruct clinic management while corresponding studies at high altitude were few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing. Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases. Conclusion: In Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

10.21203/rs.3.rs-24993/v3 ◽

2020 ◽

Author(s):

Yuxuan Lu ◽

Cidan Zhuoga ◽

Haiqiang Jin ◽

Feiqi Zhu ◽

Yuhua Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young Adult ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

High Altitude ◽

Intravenous Thrombolysis ◽

Categorical Variables ◽

Anterior Circulation ◽

Tibet Autonomous Region

Abstract Background: Numerous studies of acute ischemic stroke (AIS) have been conducted at low altitude regions, and the related findings were used to instruct clinic management while corresponding studies at high altitude are few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing. Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases. Conclusion: In Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

10.21203/rs.3.rs-24993/v5 ◽

2020 ◽

Author(s):

Yuxuan Lu ◽

Cidan Zhuoga ◽

Haiqiang Jin ◽

Feiqi Zhu ◽

Yuhua Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young Adult ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

High Altitude ◽

Intravenous Thrombolysis ◽

Categorical Variables ◽

Anterior Circulation ◽

Tibet Autonomous Region

Abstract Background: Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing.Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases.Conclusion: In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Characteristics of Acute Ischemic Stroke in Hospitalized Patients in Tibet: A Retrospective Comparative Study

10.21203/rs.3.rs-24993/v1 ◽

2020 ◽

Author(s):

Yuxuan Lu ◽

Cidan Zhuoga ◽

Haiqiang Jin ◽

Feiqi Zhu ◽

Yuhua Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young Adult ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

High Altitude ◽

Intravenous Thrombolysis ◽

Categorical Variables ◽

Anterior Circulation ◽

Tibet Autonomous Region

Abstract BackgroundLots of studies of acute ischemic stroke (AIS) had been conducted at low altitude regions, and related findings were used to instruct clinic management while corresponding studies at high altitude were few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing.MethodsThis study included diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.ResultsIn total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases.ConclusionIn Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

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Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

10.21203/rs.3.rs-24993/v4 ◽

2020 ◽

Author(s):

Yuxuan Lu ◽

Cidan Zhuoga ◽

Haiqiang Jin ◽

Feiqi Zhu ◽

Yuhua Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young Adult ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

High Altitude ◽

Intravenous Thrombolysis ◽

Categorical Variables ◽

Anterior Circulation ◽

Tibet Autonomous Region

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Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1709946 ◽

2020 ◽

Vol 11 (02) ◽

pp. 315-324

Author(s):

Suman Das ◽

Gourango Prosad Mondal ◽

Ramesh Bhattacharya ◽

Kartick Chandra Ghosh ◽

Sarbajit Das ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Unfavorable Outcome ◽

Anterior Circulation ◽

Chads2 Score ◽

National Medical ◽

Arterial Blood ◽

Increased Risk

Abstract Background Thrombolysis improves the outcome in acute ischemic stroke (AIS), albeit with an increased risk of symptomatic intracranial hemorrhage (sICH). Biomarkers to find patients at risk of sICH, and guide treatment and prognosis would be valuable. Methods Consecutive patients of AIS thrombolysed between February 2017 and September 2019 at Calcutta National Medical College were studied prospectively for sICH and outcome at 6-month follow-up. We identified the independent risk factors for unfavorable outcomes, mortality, and sICH using multivariate analysis. Prethrombolysis and 24-hour postthrombolysis fibrinogen levels were estimated to evaluate its biomarker role. Results Out of 180 AIS patients admitted during the study period, 60 patients were thrombolysed. Door to needle time was <3 hours among 24 patients and 3 to 4.5 hours among 36 patients. Favorable outcomes occurred among 76.67% and sICH occurred among 13.33% patients. Upper tertile of National Institute of Health Stroke Scale (NIHSS) had the highest adjusted odds for sICH (17.5 [95% confidence intervals=1.7–178.44]). Total anterior circulation stroke had the highest adjusted odds for unfavorable outcome (19.11 [3.9–92.6]). Following thrombolysis, the mean (standard deviation) fibrinogen level of 449.27 (32.87) decreased 7% to postthrombolysis level of 420 (20.5; p< 0.0001). Higher tertiles of fibrinogen levels had progressively increasing odds for morbidity and sICH. Conclusion Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke (double weight), i.e., CHADS2 score >2, low ejection fraction, the occurrence of total anterior circulation stroke and higher mean arterial blood pressure, blood glucose level, NIHSS score, and fibrinogen at admission were the common risk factors significantly predicting postthrombolysis sICH and morbidity. Antiplatelet and anticoagulant therapy, lower ASPECT (Alberta Stroke Program Early CT Score), and higher SEDAN scores also predicted sICH . Fibrinogen levels were significantly higher among those developing sICH and having unfavorable outcome. The performance of thrombolysis within 3 hours or between 3 and 4.5 hours after symptom onset did not affect morbidity, mortality, or the occurrence of sICH.

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Abstract WMP117: Patterns of All Bleeding Complications Associated with r-tPA Use-experience of an Acadamic Center in China

Stroke ◽

10.1161/str.48.suppl_1.wmp117 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hong Chang ◽

Xiaojuan Wang ◽

Yuchen Qiao ◽

Jie Zhao ◽

Haiqing Song

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Tissue Type ◽

Bleeding Complications ◽

High Systolic Blood Pressure ◽

Gingival Bleeding ◽

Hemorrhagic Event ◽

Hemorrhagic Complications

Background and objective: Rapid administration of intravenous recombinant tissue-type plasminogen activator (rt-PA) is the standard treatment for patients with acute ischemic stroke (AIS). While hemorrhage represents as an important and unpredictable complication of thrombolytic treatment, few studies have specifically assessed the prevalence and predictors of bleeding complications among AIS patients in Asia. We assessed characteristics of hemorrhagic complications after intravenous thrombolysis in Chinese AIS patients. Methods: This single-academic-center study retrospectively evaluated 351 acute ischemic stroke patients who received rt-PA intravenously from April 2011 to April 2016. The occurrence and characteristics of any hemorrhagic complications, as well as their associated risk factors were recorded and summarized. Multivariate logistic regression was conducted to analyze significant predictors of bleeding. Results: 134 (38.1%) patients experienced one hemorrhagic event in one or more locations The top seven common sites were gingiva (49.3%), skin (18.3%), urinary system (10.4%), digestive tract (7.5%), intra-cranial cavity (7.5%), mouth (4.4%) and nasal cavity (2.2%). All the gingival bleeding occurred during 1 to 24 hours after thrombolysis and was the first sign of bleeding. Intracranial hemorrhage (both symptomatic and asymptomatic) occurred in 16 patients, of whom 4 presented first with gingival bleeding. Multivariate analysis showed that high systolic blood pressure (SBP) and National Institutes of Health Stroke Scale (NIHSS) score were independent risk factors for hemorrhage post thrombolysis (P<0.05). Conclusions: One out of three AIS patients in this study had a bleeding complication. The most common site of initial hemorrhage after intravenous thrombolysis was gingival, which frequently occurred as the initial bleeding site within 24 hours after thrombolysis. Consistent with literature, elevated SBP and higher NIHSS were the two key predictors of bleeding risk.

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