scholarly journals Prognostic analysis of different therapeutic regimens in patients with acute cardiogenic cerebral embolism

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lan Hu ◽  
Guangxin Duan ◽  
Yuan Xu ◽  
Yongjun Cao
Keyword(s):  
Antiplatelet Therapy ◽  
Laboratory Data ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Good Prognosis ◽  
Cerebral Embolism ◽  
Effective Treatment Option ◽  
Stroke Subtype ◽  
Prognostic Analysis ◽  
Significant Difference

Abstract Background Few studies focused on the functional outcomes of patients at 3 months after receiving intravenous thrombolysis, anticoagulation, or antiplatelet therapy within 4.5 h of onset of the cardiogenic cerebral embolism (CCE) subtype. Methods The purpose of this retrospective study was to analyse the clinical data of patients with acute CCE and compare the 3-month functional prognoses of patients after administration of different antithrombotic therapies within 4.5 h of stroke onset. A total of 335 patients with CCE hospitalized in our institution were included in this study. The patients were stratified according to the hyperacute treatment received, and baseline clinical and laboratory data were analysed. A 3-month modified Rankin scale (mRS) score of 0–2 was defined as an excellent functional outcome. Results A total of 335 patients were divided into thrombolytic (n = 78), anticoagulant (n = 88), and antiplatelet therapy groups (n = 169). A total of 164 patients had a good prognosis at 3 months (mRS ≤ 2). After adjustments were made for age and National Institute of Health Stroke Scale (NIHSS) score, each group comprised 38 patients, and there were no significant differences in sex composition, complications, lesion characteristics, or Oxfordshire Community Stroke Project (OSCP) classification among the three groups. The plasma D-dimer level (µg/ml) in the thrombolytic group was significantly higher than those in the anticoagulant and antiplatelet groups [3.07 (1.50,5.62), 1.33 (0.95,1.89), 1.61 (0.76,2.96), P < 0.001]. After one week of treatment, the reduction in NIHSS in the thrombolytic group was significantly greater than those in the other two groups [3.00 (1.00, 8.00), 1.00 (0.00, 5.00), 1.00 (0.00, 2.00), P = 0.025]. A total of 47 patients (41.2 %) had an mRS score of ≤ 2 at 3 months, and 23 patients died (20.2 %). There was no significant difference in the proportion of patients with a good prognosis or the mortality rate among the three groups (P = 0.363, P = 0.683). Conclusions Thrombolytic therapy is effective at improving short-term and 3-month prognoses. Anticoagulant therapy may be a safe and effective treatment option for patients with the cardiac stroke subtype who fail to receive intravenous recombinant tissue plasminogen activator (r-tPA) thrombolysis within 4.5 h in addition to antiplatelet therapy, as recommended by the guidelines.

scholarly journals Prognostic Analysis of Different Therapeutic Regimens in Patients With Acute Cardiogenic Cerebral Embolism

2021 ◽  
Author(s):  
Lan Hu ◽  
Guangxin Duan ◽  
Yuan Xu ◽  
Yongjun Cao
Keyword(s):  
Antiplatelet Therapy ◽  
Anticoagulant Therapy ◽  
Time Window ◽  
Financial Burden ◽  
Laboratory Data ◽  
Intravenous Thrombolysis ◽  
Cerebral Embolism ◽  
Study Cohort ◽  
Concomitant Disease ◽  
Effective Treatment Option

Abstract Background Intravenous rt-PA within 4.5h can reduce the degree of disability of acute ischemic stroke at 3 months, it is limited by the time of onset, the financial burden, or the risk of bleeding that the patient and his or her family consider, rt-PA is available to a very small number of patients.In practical clinical work, anticoagulant therapy and antiplatelet therapy within the 4.5h period of acute cardiogenic cerebral embolism (CCE) are more common. Few previous studies have observed and analyzed the functional outcomes at 3-month after receiving intravenous thrombolysis, or anticoagulation, or antiplatelet therapy within 4.5h from onset of cardiogenic cerebral embolism subtype. Methods The purpose of our study was to analyze clinical baseline data of patients with acute cardiogenic cerebral embolism and compare 3-month prognosis after different antithrombotic therapies administered within 4.5h from event onset. Our retrospective study cohort consisted of 335 patients with CCE hospitalized at the Second Affiliated Hospital of Soochow University in China from December 2011 to December 2016. Patients were assigned to a group according to early-acute treatment therapy. Baseline, clinical, and laboratory data, and 3-month prognosis were analyzed. Results We found that the most common cause of CCE was non-valvular atrial fibrillation (96.2%, 85.2%, and 95.3%) and the most common concomitant disease was hypertension (88.5%, 70.5%, and 78.7%) in the thrombolytic-, anticoagulant-, and antiplatelet-treated group, respectively. The overall intracranial hemorrhagic conversion rate hemorrhage in the acute phase of CCE (during hospitalization) in our cohort was high (26 cases, 7.8%), with the highest incidence in the thrombolytic group (13 cases, 16.7%),4 cases experienced extracranial (1.2%, P = 0.316).; further, 164 cases showed good prognosis at 3 months as measured using the modified Rankin Scale (mRS ≤ 2), with the majority of cases in the anticoagulant group (P = 0.018). Conclusions Anticoagulant therapy may be a safe and effective treatment option for patients with cardiac stroke subtype who fail to receive intravenous rtPA thrombolysis within the thrombolytic time window.

Dual Antiplatelet Therapy after Intravenous Thrombolysis for Acute Minor Ischemic Stroke

2019 ◽  
Vol 82 (4-6) ◽  
pp. 93-98 ◽  
Author(s):  
Guangjian Zhao ◽  
Fanzhen Lin ◽  
Ziran Wang ◽  
Xiaolin Shao ◽  
Yanxue Gong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Recurrence ◽  
Minor Ischemic Stroke ◽  
Significant Difference ◽  
Scale Scores ◽  
Symptomatic Intracranial Hemorrhage

Objective: To verify the efficacy and safety of dual antiplatelet therapy after intravenous thrombolysis for acute minor ischemic stroke (AMIS). Methods: AMIS patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from January to October 2018 were retrospectively analyzed and divided into the aspirin (ASP) and ASP + clopidogrel (ASP-CLO) groups based on the type of antiplatelet therapy to compare the rates of good clinical outcome, symptomatic intracranial hemorrhage (SICH) after thrombolysis, and mortality in 90 days. Results: A total of 207 patients were included (group ASP, 105 patients; group ASP-CLO, 102 patients). There was no significant difference in the baseline clinical data between the 2 groups. The ­90-day modified Rankin scale scores (66.7 vs. 82.4%, p = 0.009) showed a statistically significant difference, but SICH (1.0 vs. 1.0%, p = 0.917) and 90-day mortality (1.9 vs. 1.0%, p = 0.585) showed no significant difference between the 2 groups. Conclusions: Short-term (21 days) dual antiplatelet therapy after rt-PA intravenous thrombolysis for AMIS can improve the prognosis, reduce the risk of stroke recurrence, without increasing the risk of bleeding and mortality.

Abstract 2841: Intravenous Thrombolysis For Minor Strokes: Outcome In A Cohort Of Patients Treated Through Telemedicine

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Salah G Keyrouz ◽  
Archana Hinduja
Keyword(s):  
Laboratory Data ◽  
Intravenous Thrombolysis ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Significant Difference ◽  
Methodological Problems ◽  
Prospective Database

Objective: to determine the outcome of patients with minor strokes who receive intravenous thrombolysis in a telestroke network. Background: The Arkansas SAVES (Stroke Assistance through Virtual Emergency Support) telestroke network provided emergency evaluation and therapy for acute stroke to 22 spoke sites statewide between November 2008 and May 2011. While there is little question regarding safety of IV thrombolysis in minor strokes, its impact on long-term outcome is equivocal. Few studies, yet with methodological problems attempted to answer this question. Methods: Institutional IRB approval was obtained to review the prospective database of the Arkansas SAVES program. We included patients with admission NIHSS ≤ 4. They were divided into two groups based on whether or not they received IV thrombolysis. Baseline characteristics, risk factors, laboratory data and outcomes were compared between the two groups. Good outcome was defined as mRS < 2 and excellent outcome as mRS < 1, at 90 days. For statistical analysis, we used independent T, and fisher’s exact tests. Results: The cohort included 562 patients receiving a teleconsultation between November 2008 and May 2011, of whom 116 underwent IV thrombolysis. Sixty patients with admission NIHSS ≤ 4 were included in this analysis. Patients who received IV thrombolysis had a trend towards a higher mean admission NIHSS (3.5 ± 0.7 vs. 3.9 ± 1.0, p = 0.085). There was no statistically significant difference in the percentage of good (76.7% vs. 73.3%, p = NS) or excellent outcome (60.0% vs. 56.7%, p = NS) between the two groups. The mean admission NIHSS was similar in patients with mRS<1 and mRS>1 (3.6 ± 0.9 vs. 3.7 ± 0.9, p = NS), possibly indicating a disconnect between stroke severity, when mild, and overall outcome. Conclusion: Intravenous thrombolysis did not improve outcomes in patients with minimal deficits. The use of IV thrombolytics in patients with minor strokes should be individualized depending on the type of deficits and potential disability. A larger randomized trial is needed to confirm those results.

scholarly journals Outcomes of patients with large middle cerebral artery infarct treated with and without intravenous thrombolysis

2016 ◽  
Vol 7 (01) ◽  
pp. 36-39
Author(s):  
Pornpatr A. Dharmasaroja ◽  
Sombat Muengtaweepongsa
Keyword(s):  
Intracerebral Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Demographic Data ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Severe Stroke ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Middle Cerebral Artery Infarct

ABSTRACT Background: Many thrombolytic studies showed that severe stroke was associated with death and having symptomatic intracerebral hemorrhage and inversely related to a favorable outcome. Aims: The purpose of this study is to compare the outcomes of patients with acute large middle cerebral artery (MCA) infarction with and without intravenous recombinant-tissue-plasminogen activator (rtPA) treatment. Methods: Patients with acute, large MCA infarction (National Institute of Health Stroke Scale [NIHSS] >15) who were treated during 2011–2014 were studied. The demographic data and the outcomes were compared between patients with and without intravenous rtPA treatment. Results: Two hundred and forty patients were included. Mean NIHSS score was 20. One hundred and twenty patients were treated with intravenous rtPA treatment. The patients with rtPA treatment had higher rates of favorable outcomes (39% vs. 17%, P < 0.001) and lower mortality rate (16% vs. 51%, P < 0.001). There was no significant difference in the occurrence of symptomatic intracerebral hemorrhage (6% vs. 4%, P = 0.715). Conclusions: The study showed the benefit and safety of intravenous rtPA treatment in patients with acute large MCA infarct.

Abstract TP64: Intravenous Thrombolysis in Chinese Patients with Mild Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiqi Chen ◽  
Yuesong Pan ◽  
Xingquan Zhao ◽  
Liping Liu ◽  
Hao Li ◽  
...  
Keyword(s):  
Conditional Logistic Regression ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Subtype ◽  
Stroke Registry ◽  
Good Outcome ◽  
Mild Stroke

Objectives: Thrombolysis treatment for patients with mild stroke is controversial. The aim of this study is to investigate whether patients with mild stroke or its specific etiologic subtype could benefit from recombinant tissue plasminogen activator (rt-PA) therapy. Methods: Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database and (2) the China National Stroke Registry database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype. Good functional outcome was defined as modified Rankin Scale 0-1 at 3 months. Odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated using conditional logistic regression in total patients and by etiologic subtype, respectively. Results: A total of 134 rt-PA treated patients were matched to 249 non-rt-PA treated patients in the study. Among them, 104 (76%) rt-PA-treated patients with mild stroke had good outcome after 3 months compared with 173 (69.5%) non-rt-PA-treated matching cases (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.91-2.43; P=0.12). Compared with non-rt-PA treatment group, rt-PA-treated patients had good outcome after 3 months in those with stroke subtype of large-artery atherosclerosis (LAA) (80.5% vs 65.1%; OR, 2.19; 95%CI, 1.14-4.21; P=0.02). Conclusions: For patients with mild stroke, intravenous rt-PA treatment may be effective. Patients with stroke subtype of LAA could benefit more from intravenous rt-PA treatment.

scholarly journals Levels of Fibrin Degradation Products at Admission With Acute Ischemic Stroke Correlate With the NIH Stroke Scale Score 1 h After Intravenous Thrombolysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Bin Zhu ◽  
Limin Zhang ◽  
Wanliang Du ◽  
Jie Yang ◽  
Yue Tian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Degradation Products ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Nihss Score ◽  
Fibrin Degradation Products ◽  
Significant Difference ◽  
Thrombolytic Effect ◽  
Laboratory Examinations

Background: Fibrin degradation products (FDPs) are fragments released by the plasmin-mediated degradation of fibrinogen or fibrin. Whether plasma levels of these fragments can predict the thrombolytic effect of recombinant tissue plasminogen activator (r-tPA) remains unknown.Methods: We performed a hospital-based study of patients with acute ischemic stroke (AIS) to explore the relationship between FDP levels at admission and the NIH Stroke Scale (NIHSS) score 1 h after thrombolysis treatment. In this retrospective, single-center study, the data of all patients with AIS who received r-tPA treatment at Beijing Tiantan Hospital from January 2019 to October 2020 were collected and analyzed. Demographic and clinical data, including laboratory examinations, were also analyzed.Results: A total of 339 patients with AIS were included in this study. Of these, 151 showed favorable effects of r-tPA, and 188 showed unsatisfactory effects at 1 h after thrombolysis. Overall, we found an inverse relationship between the FDPs levels at admission and the NIHSS score. A significant difference was observed when using the interquartile range of the FDPs levels (1.31 μg/mL) as a cutoff value (P = 0.003, odds ratio [OR] = 1.95, 95% confidence interval [CI]: 1.26–3.01), even after adjusting for confounding factors (P = 0.003, OR = 2.23, 95% CI: 1.31–3.77). In addition, significant associations were observed in the tertile (T3) and quartile (Q3, Q4) FDP levels when compared with T1 or Q1. A nomogram was also employed to create a model to predict an unsatisfactory effect of r-tPA. We found that FDP levels, white blood cell count, age, D-dimer level, and body mass index could influence the thrombolytic effect of r-tPA.Conclusion: In conclusion, the present study demonstrated that the levels of FDPs at admission can be used as a prognostic factor to predict the curative effect of r-tPA.

Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

2020 ◽  
Vol 17 ◽  
Author(s):  
Jie Chen ◽  
Fu-Liang Zhang ◽  
Shan Lv ◽  
Hang Jin ◽  
Yun Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Leukocyte Count ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Independence ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

scholarly journals OP0313 PRELIMINARY CRITERIA FOR MACROPHAGE ACTIVATION SYNDROME ASSOCIATED WITH CORONAVIRUS DISEASE-19

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 191.1-192
Author(s):  
S. Amikishiyev ◽  
M. G. Gunver ◽  
M. Bektas ◽  
S. Aghamuradov ◽  
B. Ince ◽  
...  
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Laboratory Data ◽  
Disease Onset ◽  
Dynamic Changes ◽  
Ferritin Concentration ◽  
Neutrophil Lymphocyte Ratio ◽  
Significant Difference ◽  
D Dimer ◽  
Activation Syndrome

Background:COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.Objectives:To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.Methods:PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.Results:A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.Table 1.Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-191.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.21 point for each positive item assessed on Days 5-7Score calculation: Total points / 12 x 100Possible MAS ≥45 and Definite MAS ≥60Conclusion:This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.Disclosure of Interests:None declared.

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