Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke

Publication

Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke

Journal Paper/Review - Feb 1, 2016

Gensicke Henrik, Bonati Leo H, Curtze Sami, Erdur Hebun, Sibolt Gerli, Koch Peter, Vandelli Laura, Ringleb Peter, Leys Didier, Cordonnier Charlotte, Michel Patrik, Nolte Christian H, Lyrer Philippe A, Tatlisumak Turgut, Nederkoorn Paul J, Engelter Stefan T, Peters Nils, Putaala Jukka, Traenka Christopher, Strbian Daniel, Zinkstok Sanne M, Scheitz Jan F, Bill Olivier, Hametner Christian, Moulin Solène, Zini Andrea, Kägi Georg, Pezzini Alessandro, Padjen Visnja, Béjot Yannick, Corbiere Sydney, Zonneveld Thomas P, Seiffge David J, Roos Yvo B

Citation

Gensicke H, Bonati L, Curtze S, Erdur H, Sibolt G, Koch P, Vandelli L, Ringleb P, Leys D, Cordonnier C, Michel P, Nolte C, Lyrer P, Tatlisumak T, Nederkoorn P, Engelter S, Peters N, Putaala J, Traenka C, Strbian D, Zinkstok S, Scheitz J, Bill O, Hametner C, Moulin S, Zini A, Kägi G, Pezzini A, Padjen V, Béjot Y, Corbiere S, Zonneveld T, Seiffge D, Roos Y. Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke. Stroke 2016; 47:450-6.

Type

Journal Paper/Review (English)

Journal

Stroke 2016; 47

Publication Date

Feb 1, 2016

Issn Electronic

1524-4628

Pages

450-6

Brief description/objective

BACKGROUND AND PURPOSE
We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live alone without help of another person before stroke (dependent patients) versus independent ones.

METHODS
In a multicenter IVT-register-based cohort study, we compared previously dependent (prestroke modified Rankin Scale score, 3-5) versus independent (prestroke modified Rankin Scale score, 0-2) patients. Outcome measures were poor 3-month outcome (not reaching at least prestroke modified Rankin Scale [dependent patients]; modified Rankin Scale score of 3-6 [independent patients]), death, and symptomatic intracranial hemorrhage. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (OR [95% confidence interval]) were calculated.

RESULTS
Among 7430 IVT-treated patients, 489 (6.6%) were dependent and 6941 (93.4%) were independent. Previous stroke, dementia, heart, and bone diseases were the most common causes of preexisting dependency. Dependent patients were more likely to die (ORunadjusted, 4.55 [3.74-5.53]; ORadjusted, 2.19 [1.70-2.84]). Symptomatic intracranial hemorrhage occurred equally frequent (4.8% versus 4.5%). Poor outcome was more frequent in dependent (60.5%) than in independent (39.6%) patients, but the adjusted ORs were similar (ORadjusted, 0.95 [0.75-1.21]). Among survivors, the proportion of patients with poor outcome did not differ (35.7% versus 31.3%). After adjustment for age and stroke severity, the odds of poor outcome were lower in dependent patients (ORadjusted, 0.64 [0.49-0.84]).

CONCLUSIONS
IVT-treated stroke patients who were dependent on the daily help of others before stroke carry a higher mortality risk than previously independent patients. The risk of symptomatic intracranial hemorrhage and the likelihood of poor outcome were not independently influenced by previous dependency. Among survivors, poor outcome was avoided at least as effectively in previously dependent patients. Thus, withholding IVT in previously dependent patients might not be justified.