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Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence
BACKGROUND: The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase. METHODS: This observational study included patient...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625889/ https://www.ncbi.nlm.nih.gov/pubmed/37936866 http://dx.doi.org/10.2147/NDT.S434296 |
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author | Li, Ning Zhang, Jia Li, Si-Jia Du, Yang Zhou, Qi Gu, Hong-Qiu Zhao, Xing-Quan |
author_facet | Li, Ning Zhang, Jia Li, Si-Jia Du, Yang Zhou, Qi Gu, Hong-Qiu Zhao, Xing-Quan |
author_sort | Li, Ning |
collection | PubMed |
description | BACKGROUND: The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase. METHODS: This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes. RESULTS: A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22–8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17–4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02–0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91–3.55) and depression (OR, 1.54; 95% CI, 0.17–2.91) in female. CONCLUSION: Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0–5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future. |
format | Online Article Text |
id | pubmed-10625889 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-106258892023-11-07 Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence Li, Ning Zhang, Jia Li, Si-Jia Du, Yang Zhou, Qi Gu, Hong-Qiu Zhao, Xing-Quan Neuropsychiatr Dis Treat Original Research BACKGROUND: The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase. METHODS: This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes. RESULTS: A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22–8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17–4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02–0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91–3.55) and depression (OR, 1.54; 95% CI, 0.17–2.91) in female. CONCLUSION: Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0–5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future. Dove 2023-11-01 /pmc/articles/PMC10625889/ /pubmed/37936866 http://dx.doi.org/10.2147/NDT.S434296 Text en © 2023 Li et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Li, Ning Zhang, Jia Li, Si-Jia Du, Yang Zhou, Qi Gu, Hong-Qiu Zhao, Xing-Quan Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title | Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title_full | Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title_fullStr | Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title_full_unstemmed | Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title_short | Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence |
title_sort | multidimensional outcomes of iv thrombolysis in minor ischemic stroke: motor, psychocognitive, and dependence |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625889/ https://www.ncbi.nlm.nih.gov/pubmed/37936866 http://dx.doi.org/10.2147/NDT.S434296 |
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