Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke
| Autor: | Christian H. Nolte, Thomas P. Zonneveld, Yannick Béjot, Christian Hametner, Stefan T. Engelter, Didier Leys, Andrea Zini, Laura Vandelli, Jukka Putaala, Olivier Bill, Leo H. Bonati, Yvo B. Roos, Patrik Michel, Georg Kägi, Henrik Gensicke, Alessandro Pezzini, Nils Peters, Peter Arthur Ringleb, Turgut Tatlisumak, Jan F. Scheitz, Daniel Strbian, Peter M. Koch, Christopher Traenka, David J. Seiffge, Paul J. Nederkoorn, Charlotte Cordonnier, Sami Curtze, Visnja Padjen, Hebun Erdur, Sanne M. Zinkstok, Gerli Sibolt, Solène Moulin, Philippe A. Lyrer, Sydney Corbiere |
|---|---|
| Přispěvatelé: | Département de neurologie - Department of neurology [Hôpital de Bâle], Hôpital Universitaire de Bâle, Hirnschlagzentrum - Stroke center [Hôpital de Bâle], Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, Registre Dijonnais des Accidents Vasculaires Cérébraux (AVC) - Dijon Stroke Registry, UNICANCER-UNICANCER-Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Felix Splatter Hospital [Bâle], Stroke-[Hirnschlag]-Fund Basel, Swiss National Foundation (Grant number : 33CM30-124119 et 33CM30-140340/1 ), University of Basel, Centre d'épidémiologie des populations ( CEP ), Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ), Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ) -Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Neurology, ANS - Neurovascular Disorders, Graduate School, ACS - Amsterdam Cardiovascular Sciences |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_treatment 030204 cardiovascular system & hematology law.invention Cohort Studies 0302 clinical medicine Randomized controlled trial law Modified Rankin Scale Activities of Daily Living 80 and over Thrombolytic Therapy Registries Stroke risk Aged 80 and over preexisting disability Medicine (all) survivors Thrombolysis Middle Aged 3. Good health Treatment Outcome Infusions intravenous Intracranial hemorrhages Outcome assessment (health care) Survivors Administration Intravenous Aged Female Humans Logistic Models Independent Living Neurology (clinical) Cardiology and Cardiovascular Medicine Advanced and Specialized Nursing controlled-trial Administration [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] acute ischemic-stroke hemorrhage Cohort study medicine.medical_specialty intracranial hemorrhages statins scale 03 medical and health sciences Internal medicine medicine Dementia outcome assessment (health care) reliability business.industry Odds ratio medicine.disease Confidence interval infusions Surgery [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] intravenous iv thrombolysis business 030217 neurology & neurosurgery |
| Zdroj: | Stroke Stroke, American Heart Association, 2016, 47 (2), pp.450-456. ⟨10.1161/STROKEAHA.115.011674⟩ Stroke, American Heart Association, 2016, 47 (2), pp.450-456. 〈10.1161/STROKEAHA.115.011674〉 Stroke; a journal of cerebral circulation, 47(2), 450-+. Lippincott Williams and Wilkins |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|