Abstract
BackgroundSpecific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated.MethodsRetrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Improving (NIHSS score ≤ 7) or worsening (NIHSS score > 7) of neurologic functions were the determined measures of treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or improving neurologic functions.ResultsAdjusted multivariate analysis showed that in an AIS population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015–1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098–3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246–0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297–0.827, P = 0.007) showed an association with improving or progressing neurologic functions.ConclusionA prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions. While combining statin with rtPA treatment may facilitate worsening neurologic functions in elderly AIS patients with atrial fibrillation, they should not be denied of this therapy. The decision to combine statin and rtPA for AIS patients with atrial fibrillation can be done after clinical stabilization following appropriate clinical management.
Highlights
The function of cholesterol reducers, such as statins in the primary and secondary prevention of stroke in patients at risk of cerebrovascular events is well established [1,2,3]
Patients with a National Institute of Health Stroke Scale (NIHSS) score of equal to or less than 7 at the time of admission demonstrate a higher likelihood of making positive neurological progress after an acute ischemic stroke (AIS), while NIHSS scores greater than 7 on admission demonstrated a higher probability of worsening neurological function in hemispheric strokes [19, 20]
The analysis included patients that presented within 24 h of symptom onset with an AIS based on brain magnetic resonance image (MRI) or computer tomography (CT) findings demonstrating early signs of ischemia or middle cerebral artery (MCA) hyperdensity
Summary
The function of cholesterol reducers, such as statins in the primary and secondary prevention of stroke in patients at risk of cerebrovascular events is well established [1,2,3]. Findings reveal that statins reduce the risk of first and recurrent ischemic strokes [4, 5] and may improve treatment outcomes through pleiotropic nonstatin-associated effects [6]. The current study is focused on clinical risk factors associated with positive or poor presenting neurological symptoms in hemispheric ischemic stroke patients with prior cholesterol reducer use. Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. Clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, a statin and rtPA therapy was investigated
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