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Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry

BACKGROUND: The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed t...

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Autores principales: Reuter, Björn, Gumbinger, Christoph, Sauer, Tamara, Wiethölter, Horst, Bruder, Ingo, Diehm, Curt, Ringleb, Peter A., Kern, Rolf, Hacke, Werner, Hennerici, Michael G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631948/
https://www.ncbi.nlm.nih.gov/pubmed/26581808
http://dx.doi.org/10.3389/fneur.2015.00229
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author Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Kern, Rolf
Hacke, Werner
Hennerici, Michael G.
author_facet Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Kern, Rolf
Hacke, Werner
Hennerici, Michael G.
author_sort Reuter, Björn
collection PubMed
description BACKGROUND: The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18–50 years. Data from a consecutive and prospective stroke registry was analyzed that covers a federal state with 10.8 million inhabitants in southwest Germany. METHODS: Our analysis comprises 51,735 ischemic stroke patients aged 18–80 years and hospitalized from January 2008 to December 2012. Of these, 4,140 (8%) were aged 18–50 years and 7,529 (15%) underwent IVT. Data on 8,439 patients (16% of the study population) were missing for National Institutes of Health stroke severity score at admission and/or modified Rankin Scale (mRS) at discharge and were excluded from outcome analysis. In sensitivity analysis, patients with incomplete data were also examined. Binary logistic regression models were used adjusted for patient, hospital, and procedural parameters and stratified by age group (18–50 and 51–80 years, subgroup analyses 18–30, 31–40, and 41–50 years) to assess the relationship between IVT and mRS at discharge. RESULTS: IVT appears equally effective in young adults 18–50 years (adjusted odds ratio 1.40, 95% confidence interval 1.12–1.75; p = 0.003), compared to patients 51–80 years of age (1.33, 1.23–1.43; p < 0.001). Age-stratified analyses suggest an inverse relation of age and effectiveness, which appears to be highest in very young patients 18–30 years of age (2.78, 1.10–7.05; p = 0.03). DISCUSSION: Ischemic stroke etiology, vascular dynamics, and recovery in young patients differ from those of middle and older age. The evidence from routine hospital care in Germany indicates that IVT in young stroke patients appears to be at least equally effective as in the elderly.
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spelling pubmed-46319482015-11-18 Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry Reuter, Björn Gumbinger, Christoph Sauer, Tamara Wiethölter, Horst Bruder, Ingo Diehm, Curt Ringleb, Peter A. Kern, Rolf Hacke, Werner Hennerici, Michael G. Front Neurol Neuroscience BACKGROUND: The efficacy of intravenous thrombolysis (IVT) is sufficiently proven in ischemic stroke patients of middle and older age by means of randomized controlled trials and large observational studies. However, data in young stroke patients ≤50 years are still scarce. In this study, we aimed to evaluate the effectiveness and safety of IVT in young adults aged 18–50 years. Data from a consecutive and prospective stroke registry was analyzed that covers a federal state with 10.8 million inhabitants in southwest Germany. METHODS: Our analysis comprises 51,735 ischemic stroke patients aged 18–80 years and hospitalized from January 2008 to December 2012. Of these, 4,140 (8%) were aged 18–50 years and 7,529 (15%) underwent IVT. Data on 8,439 patients (16% of the study population) were missing for National Institutes of Health stroke severity score at admission and/or modified Rankin Scale (mRS) at discharge and were excluded from outcome analysis. In sensitivity analysis, patients with incomplete data were also examined. Binary logistic regression models were used adjusted for patient, hospital, and procedural parameters and stratified by age group (18–50 and 51–80 years, subgroup analyses 18–30, 31–40, and 41–50 years) to assess the relationship between IVT and mRS at discharge. RESULTS: IVT appears equally effective in young adults 18–50 years (adjusted odds ratio 1.40, 95% confidence interval 1.12–1.75; p = 0.003), compared to patients 51–80 years of age (1.33, 1.23–1.43; p < 0.001). Age-stratified analyses suggest an inverse relation of age and effectiveness, which appears to be highest in very young patients 18–30 years of age (2.78, 1.10–7.05; p = 0.03). DISCUSSION: Ischemic stroke etiology, vascular dynamics, and recovery in young patients differ from those of middle and older age. The evidence from routine hospital care in Germany indicates that IVT in young stroke patients appears to be at least equally effective as in the elderly. Frontiers Media S.A. 2015-11-04 /pmc/articles/PMC4631948/ /pubmed/26581808 http://dx.doi.org/10.3389/fneur.2015.00229 Text en Copyright © 2015 Reuter, Gumbinger, Sauer, Wiethölter, Bruder, Diehm, Ringleb, Kern, Hacke, Hennerici and Stroke Working Group of Baden-Wuerttemberg. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Kern, Rolf
Hacke, Werner
Hennerici, Michael G.
Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title_full Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title_fullStr Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title_full_unstemmed Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title_short Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry
title_sort intravenous thrombolysis is effective in young adults: results from the baden-wuerttemberg stroke registry
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631948/
https://www.ncbi.nlm.nih.gov/pubmed/26581808
http://dx.doi.org/10.3389/fneur.2015.00229
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