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IV thrombolysis carries higher mortality risk for dependent patients with stroke
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Patients treated with IV thrombolysis who required assistance in daily living before stroke had a greater risk for death after treatment compared with patients who were previously independent, according to data published in Stroke.
Pre-existing dependency has often excluded patients with stroke from clinical trials of IV thrombolysis, but data from a European multicenter cohort study indicate that it might be a safe and effective treatment for both dependent and independent patients.
Researchers analyzed data from a register-based cohort study on patients treated with IV thrombolysis at 12 European stroke centers. Overall, 6.6% of the 7,430 patients treated with IV thrombolysis required living assistance before stroke. For this study, researchers determined dependency using a modified Rankin scale; dependent patients had a score of 3 to 5 and independent patients had a score of 0 to 2 before stroke, according to the study.
Primary endpoints included poor outcome at 3 months, death and symptomatic intracranial hemorrhage.
Poor outcome (60.5% vs. 39.6%) and death (38.7% vs. 12.2%) were more likely to occur in dependent patients compared with independent patients. After adjusting for confounders, previously dependent patients had a greater risk for death (adjusted OR = 2.19; 95% CI, 1.7-2.84), but not poor outcome (adjusted OR = 0.95; 95% CI, 0.75-1.21). The frequency of symptomatic intracranial hemorrhage was similar between the two groups (4.8% vs. 4.5%).
Among survivors of stroke, those who were previously dependent had a lower risk for poor outcome after the researchers adjusted for age and NIH Stroke Scale (adjusted OR = 0.64; 95% CI, 0.49-0.84).
In this study, dependent patients were typically older, female, more likely to experience severe stroke and more likely to be antithrombotic therapy compared with previously independent patients. The most common causes of prestroke dependency were history of stroke, dementia, and CV and bone diseases.
“Concerns of higher complication rates from [IV thrombolysis]-treatment resulting in a less-than-favorable risk–benefit ratio for dependent patients might be unjustified and perhaps should be set aside to allow further study,” Henrik Gensicke, MD, from the department of neurology at the University Hospital Basel in Switzerland, said in a press release. – by Tracey Romero
Disclosure: Gensicke reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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