Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke

And why pray tell would being dependent on others for your care have anything to do with eligibility for tPA?  This previous criteria should have been massively pushed back on by our incompetent stroke associations. You better hope your hospital has adjusted the tPA protocol before your next stroke if you are already dependent on others.
http://stroke.ahajournals.org/content/early/2016/01/21/STROKEAHA.115.011674.abstract

1. Henrik Gensicke, MD,
2. Daniel Strbian, MD,
3. Sanne M. Zinkstok, MD, PhD,
4. Jan F. Scheitz, MD,
5. Olivier Bill, MD,
6. Christian Hametner, MD,
7. Solène Moulin, MD, MSc,
8. Andrea Zini, MD,
9. Georg Kägi, MD,
10. Alessandro Pezzini, MD,
11. Visnja Padjen, MD, PhD,
12. Yannick Béjot, MD,
13. Sydney Corbiere, MD,
14. Thomas P. Zonneveld, MD,
15. David J. Seiffge, MD,
16. Yvo B. Roos, MD, PhD,
17. Christopher Traenka, MD,
18. Jukka Putaala, MD,
19. Nils Peters, MD,
20. Leo H. Bonati, MD,
21. Sami Curtze, MD, PhD,
22. Hebun Erdur, MD,
23. Gerli Sibolt, MD,
24. Peter Koch, MD,
25. Laura Vandelli, MD,
26. Peter Ringleb, MD,
27. Didier Leys, MD,
28. Charlotte Cordonnier, MD,
29. Patrik Michel, MD,
30. Christian H. Nolte, MD,
31. Philippe A. Lyrer, MD,
32. Turgut Tatlisumak, MD,
33. Paul J. Nederkoorn, MD, PhD,
34. Stefan T. Engelter, MD,
35. for the Thrombolysis in Stroke Patients (TriSP) Collaborators

+ Author Affiliations

1. From the Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland (H.G., S.C., D.J.S., C.T., N.P., L.H.B., P.A.L., S.T.E.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., J.P., S.C., G.S., T.T.); Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., T.P.Z., Y.B.R., P.J.N.); Department of Neurology and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany (J.F.S., H.E., P.K., C.H.N.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (O.B., P.M.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (C.H., P.R.); University Lille, Inserm, CHU Lille, U1171-Degenerative and Vascular Cognitive Disorders, Lille, France (S.M., D.L., C.C.); Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy (A.Z., L.V.); Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland (G.K.); Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy (A.P.); Department of Neurology, Clinical Centre of Serbia, Beograd, Serbia (V.P.); Department of Neurology, University Hospital, and Dijon Stroke Registry, University of Burgundy, Dijon, France (Y.B.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); and Department for Medicine of Aging and Rehabilitation, University Center, Felix Platter Hospital, Basel, Switzerland (S.T.E.).

1. 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 (OR_unadjusted, 4.55 [3.74–5.53]; OR_adjusted, 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 (OR_adjusted, 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 (OR_adjusted, 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.