Abstract
Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.
Highlights
Ischemic stroke is the most common type of stroke, responsible for approximately 87% of all strokes worldwide [1], and it can cause loss of functions, such as speaking, moving, and reading.In Taiwan, according to statistics of the Ministry of Health and Welfare (MOHW), stroke fourth highest cause of death, and similar to the data published by the American Heart Association, approximately70%–80% of stroke patients had ischemic stroke [2,3].The guideline-recommended treatment for eligible patients with acute ischemic stroke is thrombolytic therapy using recombinant tissue-type plasminogen activator to dissolve blood clots, which was approved by the U.S Food and Drug Administration in 1996 for intravenous use within 3 h of stroke [4,5]
The main feature of our study is that we considered the demographic characteristics, laboratory test results, and medical history for exploring the risk factors for poor outcomes after receiving recombinant tissue-type plasminogen activator (rt-PA)
A few studies include laboratory test results for rt-PA treatment outcome analysis and no study has investigated the associations between laboratory results and poor treatment outcome in the general population of patients with acute ischemic stroke; we found that glucose level, mean corpuscular hemoglobin concentration (MCHC), and platelet counts were associated with the treatment outcome
Summary
Ischemic stroke is the most common type of stroke, responsible for approximately 87% of all strokes worldwide [1], and it can cause loss of functions, such as speaking, moving, and reading.In Taiwan, according to statistics of the Ministry of Health and Welfare (MOHW), stroke fourth highest cause of death, and similar to the data published by the American Heart Association, approximately70%–80% of stroke patients had ischemic stroke [2,3].The guideline-recommended treatment for eligible patients with acute ischemic stroke is thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) to dissolve blood clots, which was approved by the U.S Food and Drug Administration in 1996 for intravenous use within 3 h of stroke [4,5]. Ischemic stroke is the most common type of stroke, responsible for approximately 87% of all strokes worldwide [1], and it can cause loss of functions, such as speaking, moving, and reading. 70%–80% of stroke patients had ischemic stroke [2,3]. The guideline-recommended treatment for eligible patients with acute ischemic stroke is thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) to dissolve blood clots, which was approved by the U.S Food and Drug Administration in 1996 for intravenous use within 3 h of stroke [4,5]. The guidelines recommend intravenous alteplase administration for selected patients who can be treated within 3 h or 3–4.5 h of ischemic stroke symptom onset. Physicians should review the criteria of use such as blood pressure of
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