6533b85efe1ef96bd12bf4f8
RESEARCH PRODUCT
Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke
Christian H. NolteThomas P. ZonneveldYannick BéjotChristian HametnerStefan T EngelterDidier LeysAndrea ZiniLaura VandelliJukka PutaalaOlivier BillLeo H. BonatiYvo B. RoosPatrik MichelGeorg KägiHenrik GensickeAlessandro PezziniNils PetersPeter Arthur RinglebTurgut TatlisumakJan F. ScheitzDaniel StrbianPeter M. KochChristopher TraenkaDavid J. SeiffgePaul J. NederkoornCharlotte CordonnierSami CurtzeVisnja PadjenHebun ErdurSanne M. ZinkstokGerli SiboltSolène MoulinPhilippe A. LyrerSydney Corbieresubject
Malemedicine.medical_treatment030204 cardiovascular system & hematologylaw.inventionCohort Studies0302 clinical medicineRandomized controlled triallawModified Rankin ScaleActivities of Daily Living80 and overThrombolytic TherapyRegistriesStrokeriskAged 80 and overpreexisting disabilityMedicine (all)survivorsThrombolysisMiddle Aged3. Good healthStrokeTreatment OutcomeInfusions intravenous; Intracranial hemorrhages; Outcome assessment (health care); Stroke; Survivors; Administration Intravenous; Aged; Aged 80 and over; Cohort Studies; Female; Humans; Logistic Models; Male; Middle Aged; Stroke; Treatment Outcome; Activities of Daily Living; Independent Living; Registries; Thrombolytic Therapy; Medicine (all); Neurology (clinical); Cardiology and Cardiovascular Medicine; Advanced and Specialized Nursingcontrolled-trialAdministration[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]Administration IntravenousFemaleIndependent Livingacute ischemic-strokehemorrhageCardiology and Cardiovascular MedicineCohort studymedicine.medical_specialtyintracranial hemorrhagesstatinsscale03 medical and health sciencesInternal medicinemedicineHumansDementiaAgedoutcome assessment (health care)Advanced and Specialized Nursingreliabilitybusiness.industryOdds ratiomedicine.diseaseConfidence intervalinfusionsSurgeryLogistic Models[ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]intravenousiv thrombolysisNeurology (clinical)business030217 neurology & neurosurgerydescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2016-02-01 | Stroke |