Factors associated with early neurological deterioration after intravenous thrombolysis with alteplase in patients with acute ischemic stroke

Abstract

Objective To investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital. In this study, all patients were treated with intravenous alteplase within 4.5 hours of symptom onset. Post-IVT END was recorded and defined as a neurological deterioration of ≥4 points on the National Institute of Health Stroke Scale (NIHSS) from baseline to 24 hours after IVT or leading to death. Risk factors of END were analyzed using multivariate Logistic regression model. Results Of 220 patients enrolled in this study, 34 (15.5%) experienced END. Multivariate Logistic regression analysis showed that END after IVT was associated with age (increased by every 10 years: odds ratio (OR)=1.963, 95% confidence interval (CI)=1.067-3.614), admission blood glucose (increased by every 1 mmol/L: OR=1.409, 95% CI=1.191-1.667), leucocyte count (increased by every 1×109/L: OR=1.197, 95% CI=1.018-1.409), baseline NIHSS score (increased by every 1 point: OR=1.267, 95% CI=1.091-1.475), dysphagia (OR=4.312, 95% CI=1.131-16.435), coma (OR=22.314, 95% CI=1.385-359.505), large vessel occlusion (OR=11.739, 95% CI=2.600-52.999) and cardioembolism (OR=3.671, 95% CI=1.090-12.367). Conclusions Age, admission blood glucose, leucocyte count, baseline NIHSS score, dysphagia, coma, large vessel occlusion and cardioembolism could help predict END in AIS patients treated with IVT. For patients with these risk factors, neurologists need to strengthen communication with them before IVT therapy and alteplase should be cautiously used. Close neurological monitoring of patients at risk is also necessary for detecting abnormalities promptly and proper management (early 'bridging’ endovascular therapy for instance) in time. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-OPC-15007046 Key words: Acute ischemic stroke; Alteplase; Intravenous thrombolysis; Early neurological deterioration; Risk factors