Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator
Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to is...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2020-05, Vol.49 (4), p.545-550 |
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| creator | Tanaka, Koji Matsumoto, Shoji Furuta, Konosuke Yamada, Takeshi Nagano, Sukehisa Takase, Kei-ichiro Hatano, Taketo Yamasaki, Ryo Kira, Jun-ichi |
| description | Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END
h
) or ischemic (END
i
) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END
h
and END
i
were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END
h
(3.0%) and 57 END
i
(7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08–7.72) were associated with END
h
. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36–5.64) and large artery occlusions (OR 3.09, 95% CI 1.53–6.57) were associated with END
i
. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors. |
| doi_str_mv | 10.1007/s11239-019-02015-4 |
| format | Article |
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h
) or ischemic (END
i
) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END
h
and END
i
were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END
h
(3.0%) and 57 END
i
(7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08–7.72) were associated with END
h
. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36–5.64) and large artery occlusions (OR 3.09, 95% CI 1.53–6.57) were associated with END
i
. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.</description><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-019-02015-4</identifier><identifier>PMID: 31848874</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Aged, 80 and over ; Cardiology ; Computed tomography ; Female ; Hematology ; Hemorrhage ; Humans ; Intracranial Hemorrhages - complications ; Intravenous administration ; Ischemia ; Ischemic Stroke - complications ; Ischemic Stroke - drug therapy ; Magnetic resonance imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nervous System Diseases - chemically induced ; Patients ; Recurrence ; Retrospective Studies ; Risk factors ; Stroke ; t-Plasminogen activator ; Thrombolytic drugs ; Tissue Plasminogen Activator - adverse effects</subject><ispartof>Journal of thrombosis and thrombolysis, 2020-05, Vol.49 (4), p.545-550</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-5c5b49186381e497b6c95509d53b84b14488083b316e2604d4ace51baf267e093</citedby><cites>FETCH-LOGICAL-c540t-5c5b49186381e497b6c95509d53b84b14488083b316e2604d4ace51baf267e093</cites><orcidid>0000-0001-6501-4057</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-019-02015-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-019-02015-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31848874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanaka, Koji</creatorcontrib><creatorcontrib>Matsumoto, Shoji</creatorcontrib><creatorcontrib>Furuta, Konosuke</creatorcontrib><creatorcontrib>Yamada, Takeshi</creatorcontrib><creatorcontrib>Nagano, Sukehisa</creatorcontrib><creatorcontrib>Takase, Kei-ichiro</creatorcontrib><creatorcontrib>Hatano, Taketo</creatorcontrib><creatorcontrib>Yamasaki, Ryo</creatorcontrib><creatorcontrib>Kira, Jun-ichi</creatorcontrib><title>Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END
h
) or ischemic (END
i
) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END
h
and END
i
were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END
h
(3.0%) and 57 END
i
(7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08–7.72) were associated with END
h
. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36–5.64) and large artery occlusions (OR 3.09, 95% CI 1.53–6.57) were associated with END
i
. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiology</subject><subject>Computed tomography</subject><subject>Female</subject><subject>Hematology</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intracranial Hemorrhages - complications</subject><subject>Intravenous administration</subject><subject>Ischemia</subject><subject>Ischemic Stroke - complications</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nervous System Diseases - chemically induced</subject><subject>Patients</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Stroke</subject><subject>t-Plasminogen activator</subject><subject>Thrombolytic drugs</subject><subject>Tissue Plasminogen Activator - adverse effects</subject><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1TAQhS0EopfCC7BAllgH_JvYGyTU8idVYgMSO8txJrmuEvtiO7fqa_GEONxSYMPCsjxz5psjH4SeU_KKEtK9zpQyrhtC62GEykY8QDsqO950gn17iHZEM91ITuQZepLzNSFEa8IeozNOlVCqEzv049KPIyQIDjLuodwABHxIMHhX_BHwaF2JKeMxJgw2zbc4wJriHCfv7IwHKJB8TLb4GPCwAi4R72GJKe1tlWAbBuyzq6X68CGvc9lg8xxvfJhqpSR7hBDXjBO4uPQ-2FBw8TlX2GG2efEhTtWU3QzZauYpejTaOcOzu_scfX3_7svFx-bq84dPF2-vGicFKY10sheaqpYrCkJ3feu0lEQPkvdK9FTUHyCK95y2wFoiBmEdSNrbkbUdEM3P0ZsT97D2CwwONq-zOSS_2HRrovXm307wezPFo-moYi3bAC_vACl-XyEXcx3XFKpnU3MTQhPVtlXFTiqXYs4JxvsNlJgtZ3PK2dScza-cjahDL_72dj_yO9gq4CdBrq0wQfqz-z_YnwQ0ukY</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Tanaka, Koji</creator><creator>Matsumoto, Shoji</creator><creator>Furuta, Konosuke</creator><creator>Yamada, Takeshi</creator><creator>Nagano, Sukehisa</creator><creator>Takase, Kei-ichiro</creator><creator>Hatano, Taketo</creator><creator>Yamasaki, Ryo</creator><creator>Kira, Jun-ichi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6501-4057</orcidid></search><sort><creationdate>20200501</creationdate><title>Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator</title><author>Tanaka, Koji ; 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We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END
h
) or ischemic (END
i
) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END
h
and END
i
were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END
h
(3.0%) and 57 END
i
(7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08–7.72) were associated with END
h
. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36–5.64) and large artery occlusions (OR 3.09, 95% CI 1.53–6.57) were associated with END
i
. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31848874</pmid><doi>10.1007/s11239-019-02015-4</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6501-4057</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of thrombosis and thrombolysis, 2020-05, Vol.49 (4), p.545-550 |
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| subjects | Aged Aged, 80 and over Cardiology Computed tomography Female Hematology Hemorrhage Humans Intracranial Hemorrhages - complications Intravenous administration Ischemia Ischemic Stroke - complications Ischemic Stroke - drug therapy Magnetic resonance imaging Male Medicine Medicine & Public Health Middle Aged Nervous System Diseases - chemically induced Patients Recurrence Retrospective Studies Risk factors Stroke t-Plasminogen activator Thrombolytic drugs Tissue Plasminogen Activator - adverse effects |
| title | Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator |
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