http://stroke.ahajournals.org/content/early/2016/01/21/STROKEAHA.115.011674.abstract
- Henrik Gensicke, MD,
- Daniel Strbian, MD,
- Sanne M. Zinkstok, MD, PhD,
- Jan F. Scheitz, MD,
- Olivier Bill, MD,
- Christian Hametner, MD,
- Solène Moulin, MD, MSc,
- Andrea Zini, MD,
- Georg Kägi, MD,
- Alessandro Pezzini, MD,
- Visnja Padjen, MD, PhD,
- Yannick Béjot, MD,
- Sydney Corbiere, MD,
- Thomas P. Zonneveld, MD,
- David J. Seiffge, MD,
- Yvo B. Roos, MD, PhD,
- Christopher Traenka, MD,
- Jukka Putaala, MD,
- Nils Peters, MD,
- Leo H. Bonati, MD,
- Sami Curtze, MD, PhD,
- Hebun Erdur, MD,
- Gerli Sibolt, MD,
- Peter Koch, MD,
- Laura Vandelli, MD,
- Peter Ringleb, MD,
- Didier Leys, MD,
- Charlotte Cordonnier, MD,
- Patrik Michel, MD,
- Christian H. Nolte, MD,
- Philippe A. Lyrer, MD,
- Turgut Tatlisumak, MD,
- Paul J. Nederkoorn, MD, PhD,
- Stefan T. Engelter, MD,
- for the Thrombolysis in Stroke Patients (TriSP) Collaborators
+ Author Affiliations
- Correspondence to Henrik Gensicke, MD, Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail henrik.gensicke@usb.ch
Abstract
Background and Purpose—We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live
alone without help of another person before stroke (dependent patients) versus independent ones.
Methods—In a
multicenter IVT-register–based cohort study, we compared previously
dependent (prestroke modified Rankin Scale score,
3–5) versus independent (prestroke modified
Rankin Scale score, 0–2) patients. Outcome measures were poor 3-month
outcome
(not reaching at least prestroke modified
Rankin Scale [dependent patients]; modified Rankin Scale score of 3–6
[independent
patients]), death, and symptomatic
intracranial hemorrhage. Unadjusted and adjusted odds ratios (ORs) with
95% confidence
intervals (OR [95% confidence interval]) were
calculated.
Results—Among 7430
IVT-treated patients, 489 (6.6%) were dependent and 6941 (93.4%) were
independent. Previous stroke, dementia, heart,
and bone diseases were the most common causes
of preexisting dependency. Dependent patients were more likely to die
(ORunadjusted, 4.55 [3.74–5.53]; ORadjusted, 2.19
[1.70–2.84]). Symptomatic intracranial hemorrhage occurred equally
frequent (4.8% versus 4.5%). Poor outcome was more
frequent in dependent (60.5%) than in
independent (39.6%) patients, but the adjusted ORs were similar (ORadjusted, 0.95 [0.75–1.21]). Among survivors, the proportion of patients with poor outcome did not differ (35.7% versus 31.3%). After
adjustment for age and stroke severity, the odds of poor outcome were lower in dependent patients (ORadjusted, 0.64 [0.49–0.84]).
Conclusions—IVT-treated
stroke patients who were dependent on the daily help of others before
stroke carry a higher mortality risk than
previously independent patients. The risk of
symptomatic intracranial hemorrhage and the likelihood of poor outcome
were not
independently influenced by previous
dependency. Among survivors, poor outcome was avoided at least as
effectively in previously
dependent patients. Thus, withholding IVT in
previously dependent patients might not be justified.
No comments:
Post a Comment