Prognostic factors in patients with acute ischemic stroke treated with intravenous tissue plasminogen activator: The first study among Iranian patients

  • Elyar Sadeghi-Hokmabadi Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Mohammad Yazdchi Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Mehdi Farhoudi Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Homayoun Sadeghi Department of Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
  • Aliakbar Taheraghdam Department of Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
  • Reza Rikhtegar Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Hannaneh Aliyar Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Sahar Mohammadi-Fallah Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Rogayyeh Asadi Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Elham Mehdizadeh-Far Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Neda Ghaemian Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Keywords: Acute Ischemic Stroke, Tissue Plasminogen Activator, Outcome, Risk Factors

Abstract

Background: Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA.Methods: A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality.Results: Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18).Conclusion: According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.

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Published
2018-01-04
How to Cite
1.
Sadeghi-Hokmabadi E, Yazdchi M, Farhoudi M, Sadeghi H, Taheraghdam A, Rikhtegar R, Aliyar H, Mohammadi-Fallah S, Asadi R, Mehdizadeh-Far E, Ghaemian N. Prognostic factors in patients with acute ischemic stroke treated with intravenous tissue plasminogen activator: The first study among Iranian patients. IJNL. 17(1):31-7.
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