Deans' stroke musings: Intravenous Thrombolysis After First-Ever Ischemic Stroke and Reduced Incident Dementia Rate

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, January 19, 2022

Intravenous Thrombolysis After First-Ever Ischemic Stroke and Reduced Incident Dementia Rate

The first goal in stroke is 100% recovery. And since you didn't measure that you obviously don't give a shit about your patients priorities.

Business 101: If you don't measure it, it is not important, so obviously 100% recovery is not important.

“What's measured, improves.” So said management legend and author Peter F. Drucker

The latest here:

Intravenous Thrombolysis After First-Ever Ischemic Stroke and Reduced Incident Dementia Rate

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Originally published30 Dec 2021https://doi.org/10.1161/STROKEAHA.121.034969Stroke. 2022;0:STROKEAHA.121.034969

Abstract

Background and Purpose:

The use of intravenous thrombolysis is associated with improved clinical outcomes(Really?). Whether thrombolysis is associated with reduced incidence of poststroke dementia remains uncertain. We sought to estimate if the use of thrombolysis following first-ever ischemic stroke was associated with a reduced rate of incident dementia using a pragmatic observational design.

Methods:

We included first-ever ischemic stroke patients from the Ontario Stroke Registry who had not previously been diagnosed with dementia. The primary outcome was incident dementia ascertained by a validated diagnostic algorithm. We employed inverse probability of treatment-weighted Cox proportional hazard models to estimate the cause-specific hazard ratio for the association of thrombolysis and incident dementia at 1 and 5 years following stroke.

Results:

From July 2003 to March 2013, 7072 patients with ischemic stroke were included, 3276 (46.3%) were female and mean age was 71.0 (SD, 12.8) years. Overall, 38.2% of the cohort (n=2705) received thrombolysis, 77.2% (n=2087) of which was administered within 3 hours of stroke onset. In the first year following stroke, thrombolysis administration was associated with a 24% relative reduction in the rate of developing dementia (cause-specific hazard ratio, 0.76 [95% CI, 0.58–0.97]). This association remained significant at 5 years (cause-specific hazard ratio, 0.79 [95% CI, 0.66–0.91]) and at the end of follow-up (median 6.3 years; cause-specific hazard ratio, 0.79 [95% CI, 0.68–0.89]).

Conclusions:

Thrombolysis administration following first-ever ischemic stroke was independently associated with a reduced rate of dementia. Incident dementia should be considered as a relevant outcome when evaluating risk/benefit of thrombolysis in ischemic stroke patients.