scholarly journals Low-Dose Statins Improve Prognosis of Patients with Ischaemic Stroke Undergoing Intra-Arterial Thrombectomy: A Prospective Cohort Study

2021 ◽  
Author(s):  
Chaohua Cui ◽  
Shuju Dong ◽  
Qian Liu ◽  
Jiajia Bao ◽  
Lijie Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Lower Percentage ◽  
High Dose ◽  
Improvement Rate ◽  
Death Rates ◽  
Nihss Score ◽  
Statin Group ◽  
Statin Use

Abstract Background: High-dose statins are recommended as preventive drugs in guidelines for patients with ischaemic stroke undergoing thrombectomy. Not only in clinical practice but also based on large-scale studies, low-dose statins have been widely used and demonstrated to be efficient in Asian populations. However, it remains unknown whether low-dose statin is related to the prognosis of patients with thrombectomy. Can low-dose statins reduce the risk of bleeding at the same time?Methods: We prospectively collected data from patients with acute ischaemic stroke undergoing intra-arterial thrombectomy. Efficacy outcomes were National Institutes of Health Stroke Scale (NIHSS) score improvement at 7 days after admission and a favourable functional outcome (FFO) at 90 days. Safety outcomes were rates of in-hospital haemorrhage events and death within 2 years. Results: We included 256 patients in this study. Compared with the control group, the low-dose statin group had a higher NIHSS improvement rate at 7 days, a higher FFO rate at 90 days and a lower death rate within 2 years. The low-dose statin group had a lower percentage of gastrointestinal haemorrhage. Statin use was significantly related to an improved NIHSS score (p=0.028, OR=1.773) at 7 days and FFO (P<0.001, OR=2.962) at 90 days and to lower death rates (P=0.025, or=0.554) within 2 years.Conclusion: In Asian acute ischaemic stroke patients with intra-arterial thrombectomy, low-dose statin use was significantly related to NIHSS improvement at 7 days, FFO at 90 days and decreased death rates within 2 years.

scholarly journals Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaohua Cui ◽  
Yanbo Li ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
Lijie Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Risk Of Bleeding

Abstract Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Low and Medium dose Statins Improve Function and Prognosis of Asian Ischemic Stroke Patients with Intravenous Thrombolysis

2021 ◽  
Author(s):  
Chaohua Cui ◽  
Jiajia Bao ◽  
Lijie Gao ◽  
Li He
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Score Improvement ◽  
Medium Dose

Abstract Background: For acute ischaemic stroke, intravenous thrombolysis combined with statins might increase the therapeutic effect; however, it is uncertain whether this is effective. Additionally, statins can increase the risk of intracerebral haemorrhage in ischaemic stroke patients, further raising doubts regarding the safety of this combination. Methods: Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events in the hospital and death events within 2 years. Results: The study finally included 222 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p<0.001) and a higher percentage of a favourable functional outcome (FFO) (p<0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p<0.001) and gastrointestinal haemorrhage (p=0.004) in the hospital and a lower percentage of death events (p<0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR=2.291, p=0.014), a lower percentage of intracerebral haemorrhage (OR=0.379, p=0.008) and gastrointestinal haemorrhage (OR=0.027, p=0.023), and a lower percentage of death events (OR=0.196, p<0.001). Conclusion: For Asian acute ischaemic stroke patients after intravenous thrombolysis, the use of low- and medium-dose statins was related to NIHSS improvement of moderate stroke patients at 7 days, with a reduced percentage of haemorrhage events in the hospital and a lower percentage of death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Thrombolysis with alteplase 3–4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances

2020 ◽  
Vol 25 (5) ◽  
pp. 168-171 ◽  
Author(s):  
Brian Scott Alper ◽  
Gary Foster ◽  
Lehana Thabane ◽  
Alex Rae-Grant ◽  
Meghan Malone-Moses ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Trial Data ◽  
Stroke Onset ◽  
Primary Efficacy ◽  
Nihss Score ◽  
Primary Efficacy Outcome ◽  
Efficacy Outcome ◽  
Free Status

ObjectivesAlteplase is commonly recommended for acute ischaemic stroke within 4.5 hours after stroke onset. The Third European Cooperative Acute Stroke Study (ECASS III) is the only trial reporting statistically significant efficacy for clinical outcomes for alteplase use 3–4.5 hours after stroke onset. However, baseline imbalances in history of prior stroke and stroke severity score may confound this apparent finding of efficacy. We reanalysed the ECASS III trial data adjusting for baseline imbalances to determine the robustness or sensitivity of the efficacy estimates.DesignReanalysis of randomised placebo-controlled trial. We obtained access to the ECASS III trial data and replicated the previously reported analyses to confirm our understanding of the data. We adjusted for baseline imbalances using multivariable analyses and stratified analyses and performed sensitivity analysis for missing data.SettingEmergency care.Participants821 adults with acute ischaemic stroke who could be treated 3–4.5 hours after symptom onset.InterventionsIntravenous alteplase (0.9 mg/kg of body weight) or placebo.Main outcome measuresThe original primary efficacy outcome was modified Rankin Scale (mRS) score 0 or 1 (ie, being alive without any disability) and the original secondary efficacy outcome was a global outcome based on a composite of functional end points, both at 90 days. Adjusted analyses were only reported for the primary efficacy outcome and the original study protocol did not specify methods for adjusted analyses. Our adjusted reanalysis included these outcomes, symptom-free status (mRS 0), dependence-free status (mRS 0–2), mortality (mRS 6) and change across the mRS 0–6 spectrum at 90 days; and mortality and symptomatic intracranial haemorrhage at 7 days.ResultsWe replicated previously reported unadjusted analyses but discovered they were based on a modified interpretation of the National Institutes of Health Stroke Scale (NIHSS) score. The secondary efficacy outcome was no longer significant using the original NIHSS score. Previously reported adjusted analyses could only be replicated with significant effects for the primary efficacy outcome by using statistical approaches not reported in the trial protocol or statistical analysis plan. In analyses adjusting for baseline imbalances, all efficacy outcomes were not significant, but increases in symptomatic intracranial haemorrhage remained significant.ConclusionsReanalysis of the ECASS III trial data with multiple approaches adjusting for baseline imbalances does not support any significant benefits and continues to support harms for the use of alteplase 3–4.5 hours after stroke onset. Clinicians, patients and policymakers should reconsider interpretations and decisions regarding management of acute ischaemic stroke that were based on ECASS III results.Trial registration numberNCT00153036.

Association Between Low-Density Lipoprotein Cholesterol Levels, Statin Use, and Dementia in Patients followed in German General Practices

2021 ◽  
Vol 79 (1) ◽  
pp. 37-46
Author(s):  
Rebecca Zingel ◽  
Jens Bohlken ◽  
Steffi Riedel-Heller ◽  
Sebastian Barth ◽  
Karel Kostev
Keyword(s):  
Vascular Dementia ◽  
Low Dose ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
High Dose ◽  
Low Density Lipoprotein Cholesterol ◽  
Dementia Diagnosis ◽  
General Practices ◽  
Statin Use ◽  
Medium Dose

Background: No studies have been conducted to date on the association between low-density lipoprotein cholesterol (LDL-C), statin use classified into low, medium, and high statin dosages, and dementia in German general practices. Objective: The goal of this retrospective case-control study was to investigate the relationship between elevated LDL-C, statins, and dementia in elderly persons followed in general practices in Germany. Methods: This study included patients aged 65 or older with an initial dementia diagnosis between January 2015 and December 2019 and at least one documented LDL-C value within the year prior to the dementia diagnosis. These patients were treated in one of 963 general practices which document LDL-C in Germany. Dementia cases were matched to non-dementia controls using propensity scores based on age, sex, and comorbidities. Logistic regression models were conducted to assess a possible association between accelerated LDL-C, statins, and dementia. Results: The study included 12,236 patients with dementia and 12,236 non-dementia controls. In total, 2,528 of the dementia patients were diagnosed with vascular dementia. The use of all dosages of statin use was negatively associated with all-cause dementia (OR: 0.80 for low dose, OR: 0.92 for medium dose, and OR: 0.85 for high dose) and with vascular dementia (OR: 0.61 for low dose, OR: 0.77 for medium dose, and OR: 0.74 for high dose). There was no clinically relevant association between elevated LDL-C and dementia. Conclusion: A negative association was found between all dosage use of statin therapy and all-cause dementia and vascular dementia in elderly patients in general practices in Germany.

scholarly journals High-dose albumin treatment for acute ischaemic stroke (ALIAS) part 2: a randomised, double-blind, phase 3, placebo-controlled trial

2013 ◽  
Vol 12 (11) ◽  
pp. 1049-1058 ◽  
Author(s):  
Myron D Ginsberg ◽  
Yuko Y Palesch ◽  
Michael D Hill ◽  
Renee H Martin ◽  
Claudia S Moy ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
High Dose ◽  
Phase 3 ◽  
Double Blind

scholarly journals Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: an updated systematic review

2018 ◽  
Vol 3 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Xia Wang ◽  
Shoujiang You ◽  
Shoichiro Sato ◽  
Jie Yang ◽  
Cheryl Carcel ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Standard Dose ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Risk Of Death ◽  
Tissue Plasminogen

The optimal dose of recombinant tissue plasminogen activator (rtPA) for acute ischaemic stroke (AIS) remains controversial, especially in Asian countries. We aimed to update the evidence regarding the use of low-dose versus standard-dose rtPA. We performed a systematic literature search across MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to 22 August 2016 to identify all related studies. The outcomes were death or disability (defined by modified Rankin Scale 2–6), death, and symptomatic intracerebral haemorrhage (sICH). Where possible, data were pooled for meta-analysis with ORs and corresponding 95% CIs by means of random-effects or fixed-effects meta-analysis. We included 26 observational studies and 1 randomised controlled trial with a total of 23 210 patients. Variable doses of rtPA were used for thrombolysis of AIS in Asia. Meta-analysis shows that low-dose rtPA was not associated with increased risk of death or disability (OR 1.13, 95% CI 0.95 to 1.33), or death (OR 0.86, 95% CI 0.74 to 1.01), or decreased risk of sICH (OR 1.06, 95% CI 0.65 to 1.72). The results remained consistent when sensitivity analyses were performed including only low-dose and standard-dose rtPA or only Asian studies. Our review shows small difference between the outcomes or the risk profile in the studies using low-dose and/or standard-dose rtPA for AIS. Low-dose rtPA was not associated with lower risk of death or disability, death alone, or sICH.

scholarly journals Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion

2021 ◽  
pp. svn-2021-001242
Author(s):  
Ximing Nie ◽  
David Wang ◽  
Yuehua Pu ◽  
Yufei Wei ◽  
Qixuan Lu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Lower Percentage ◽  
Basilar Artery Occlusion

Background and purposeIt remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO.MethodsPatients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO.ResultsOf 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01).ConclusionsThis study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

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