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Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke

Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively co...

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Autores principales: Han, Thang S., Gulli, Giosue, Fry, Christopher H., Affley, Brendan, Robin, Jonathan, Fluck, David, Kakar, Puneet, Sharma, Pankaj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791861/
https://www.ncbi.nlm.nih.gov/pubmed/34255266
http://dx.doi.org/10.1007/s11239-021-02523-2
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author Han, Thang S.
Gulli, Giosue
Fry, Christopher H.
Affley, Brendan
Robin, Jonathan
Fluck, David
Kakar, Puneet
Sharma, Pankaj
author_facet Han, Thang S.
Gulli, Giosue
Fry, Christopher H.
Affley, Brendan
Robin, Jonathan
Fluck, David
Kakar, Puneet
Sharma, Pankaj
author_sort Han, Thang S.
collection PubMed
description Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4–11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1–10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3–7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5–18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6–8.4); moderately-severe or severe disability (modified Rankin Scale  score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1–10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7–15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal–Wallis test: χ(2) = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = − 4 vs 0, χ(2) = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service.
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spelling pubmed-87918612022-02-02 Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke Han, Thang S. Gulli, Giosue Fry, Christopher H. Affley, Brendan Robin, Jonathan Fluck, David Kakar, Puneet Sharma, Pankaj J Thromb Thrombolysis Article Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4–11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1–10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3–7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5–18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6–8.4); moderately-severe or severe disability (modified Rankin Scale  score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1–10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7–15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal–Wallis test: χ(2) = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = − 4 vs 0, χ(2) = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service. Springer US 2021-07-13 2022 /pmc/articles/PMC8791861/ /pubmed/34255266 http://dx.doi.org/10.1007/s11239-021-02523-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Han, Thang S.
Gulli, Giosue
Fry, Christopher H.
Affley, Brendan
Robin, Jonathan
Fluck, David
Kakar, Puneet
Sharma, Pankaj
Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title_full Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title_fullStr Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title_full_unstemmed Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title_short Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
title_sort adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791861/
https://www.ncbi.nlm.nih.gov/pubmed/34255266
http://dx.doi.org/10.1007/s11239-021-02523-2
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