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

被引：65

作者：

Gensicke, Henrik ^{[1
,2
]}

Strbian, Daniel ^{[3
]}

Zinkstok, Sanne M. ^{[4
]}

Scheitz, Jan F. ^{[5
,6
]}

Bill, Olivier ^{[7
,8
]}

Hametner, Christian ^{[9
]}

Moulin, Solene ^{[10
]}

Zini, Andrea ^{[11
]}

Kagi, Georg ^{[12
]}

Pezzini, Alessandro ^{[13
]}

Padjen, Visnja ^{[14
]}

Bejot, Yannick ^{[15
,16
]}

Corbiere, Sydney ^{[1
,2
]}

Zonneveld, Thomas P. ^{[4
]}

Seiffge, David J. ^{[1
,2
]}

Roos, Yvo B. ^{[4
]}

Traenka, Christopher ^{[1
,2
]}

Putaala, Jukka ^{[3
]}

Peters, Nils ^{[1
,2
]}

Bonati, Leo H. ^{[1
,2
]}

Curtze, Sami ^{[3
]}

Erdur, Hebun ^{[5
,6
]}

Sibolt, Gerli ^{[3
]}

Koch, Peter ^{[5
,6
]}

Vandelli, Laura ^{[11
]}

Ringleb, Peter ^{[9
]}

Leys, Didier ^{[10
]}

Cordonnier, Charlotte ^{[10
]}

Michel, Patrik ^{[7
,8
]}

Nolte, Christian H. ^{[5
,6
]}

Lyrer, Philippe A. ^{[1
,2
]}

Tatlisumak, Turgut ^{[3
,17
]}

Nederkoorn, Paul J. ^{[4
]}

Engelter, Stefan T. ^{[1
,2
,18
]}

机构：

[1] Univ Basel Hosp, Stroke Ctr, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, Dept Neurol, Petersgraben 4, CH-4031 Basel, Switzerland

[3] Univ Helsinki, Cent Hosp, Dept Neurol, Helsinki, Finland

[4] Univ Amsterdam, Acad Med Ctr, Dept Neurol, NL-1105 AZ Amsterdam, Netherlands

[5] Charite, Dept Neurol, D-13353 Berlin, Germany

[6] Charite, Ctr Stroke Res, D-13353 Berlin, Germany

[7] CHU Vaudois, Dept Neurol, CH-1011 Lausanne, Switzerland

[8] Univ Lausanne, Lausanne, Switzerland

[9] Univ Heidelberg Hosp, Dept Neurol, Heidelberg, Germany

[10] Univ Lille, INSERM, Degenerat & Vasc Cognit Disorders U1171, CHU Lille, Lille, France

[11] AUSL Modena, Nuovo Osped Civile S Agostino Estense, Dept Neurosci, Stroke Unit, Modena, Italy

[12] Kantonsspital, Dept Neurol, St Gallen, Switzerland

[13] Univ Brescia, Neurol Clin, Dept Clin & Expt Sci, Brescia, Italy

[14] Clin Ctr Serbia, Dept Neurol, Beograd, Serbia

[15] Univ Hosp, Dept Neurol, Dijon, France

[16] Univ Burgundy, Dijon Stroke Registry, Dijon, France

[17] Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden

[18] Felix Platter Hosp, Univ Ctr, Dept Med Aging & Rehabil, Basel, Switzerland

来源：

STROKE | 2016年 / 47卷 / 02期

基金：

瑞士国家科学基金会;

关键词：

infusions; intravenous; intracranial hemorrhages; outcome assessment (health care); stroke; survivors; ACUTE ISCHEMIC-STROKE; PREEXISTING DISABILITY; CONTROLLED-TRIAL; IV THROMBOLYSIS; SCALE; RELIABILITY; HEMORRHAGE; STATINS; RISK;

D O I：

10.1161/STROKEAHA.115.011674

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 (OR adjusted, 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.

引用

页码：450 / +

页数：12

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