Abstract
IntroductionThe purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis.MethodsWe performed a retrospective review of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) between 2004–2011. We compared the outcomes of patients treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined by all grades of hemorrhagic transformation and neurologic deterioration. The secondary outcome was efficacy, determined by functional status at discharge, and in-hospital deaths.ResultsOf 427 patients included in the analysis, 89 received aggressive BP control prior to thrombolysis, 65 received standard BP control, and 273 required no BP control prior to thrombolysis. Patients requiring BP control had more severe strokes, with median arrival National Institutes of Health Stroke Scale of 10 (IQR [6–17]) in patients not requiring BP control versus 11 (IQR [5–16]) and 13 (IQR [7–20]) in patients requiring standard and aggressive BP lowering therapies, respectively (p=0.048). In a multiple logistic regression model adjusting for baseline differences, there were no statistically significant differences in adverse events between the three groups (P>0.10).ConclusionWe observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis. However, additional study is necessary to confirm or refute the safety of aggressive BP control prior to thrombolysis.
Highlights
The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis
We observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis
Of the 427 patients included in the analysis, 273 patients did not require BP control prior to thrombolysis with tissue plasminogen activator (tPA), while 65 required standard BP treatment and the remaining 89 required aggressive BP control prior to thrombolysis
Summary
The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. AIS affects over 15 million patients yearly worldwide, and represents the fifth-leading cause of death and leading cause of disability in the United States.[1] Currently, the only FDA-approved medical therapy for treatment of AIS is thrombolysis with recombinant tissue plasminogen activator (tPA) within three hours of symptom onset. Despite this being the only approved medical therapy, the majority of eligible patients remain untreated. One of the reasons for this under-treatment stems from exclusion of patients who present with elevated blood pressure (BP).[2,3,4] Prior literature has found that patient BPs in excess of the pre-thrombolytic goal of 185/110 is associated with delayed[5] and non-treatment with thrombolytics.[6] and that active management of BP in these patients is associated with an increased proportion receiving thrombolytic therapy.[7]
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