Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Autor:	Sarbajit Das, Chandrakanta Patra, Shabir Ahmed Paul, Ramesh Bhattacharya, Kartick Chandra Ghosh, Hema Krishna Pattem, Suman Das, Gourango Prosad Mondal
Rok vydání:	2020
Předmět:	medicine.medical_specialty thrombolysis medicine.medical_treatment lcsh:RC321-571 Modified Rankin Scale Internal medicine Diabetes mellitus Medicine alteplase Stroke lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry Ejection fraction modified Rankin scale business.industry General Neuroscience Thrombolysis medicine.disease Blood pressure Heart failure Cardiology Biomarker (medicine) Original Article Neurology (clinical) fibrinogen business intracranial hemorrhage
Zdroj:	Journal of Neurosciences in Rural Practice Journal of Neurosciences in Rural Practice, Vol 11, Iss 02, Pp 315-324 (2020)
ISSN:	0976-3147
Popis:	Background Thrombolysis improves the outcome in acute ischemic stroke (AIS), albeit with an increased risk of symptomatic intracranial hemorrhage (sICH). Biomarkers to find patients at risk of sICH, and guide treatment and prognosis would be valuable. Methods Consecutive patients of AIS thrombolysed between February 2017 and September 2019 at Calcutta National Medical College were studied prospectively for sICH and outcome at 6-month follow-up. We identified the independent risk factors for unfavorable outcomes, mortality, and sICH using multivariate analysis. Prethrombolysis and 24-hour postthrombolysis fibrinogen levels were estimated to evaluate its biomarker role. Results Out of 180 AIS patients admitted during the study period, 60 patients were thrombolysed. Door to needle time was Conclusion Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke (double weight), i.e., CHADS2 score >2, low ejection fraction, the occurrence of total anterior circulation stroke and higher mean arterial blood pressure, blood glucose level, NIHSS score, and fibrinogen at admission were the common risk factors significantly predicting postthrombolysis sICH and morbidity. Antiplatelet and anticoagulant therapy, lower ASPECT (Alberta Stroke Program Early CT Score), and higher SEDAN scores also predicted sICH . Fibrinogen levels were significantly higher among those developing sICH and having unfavorable outcome. The performance of thrombolysis within 3 hours or between 3 and 4.5 hours after symptom onset did not affect morbidity, mortality, or the occurrence of sICH.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e792c18ab0753d072284e000aa98fe69 https://pubmed.ncbi.nlm.nih.gov/32367987 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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