Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Koji Tanaka, Shoji Matsumoto, Konosuke Furuta, Takeshi Yamada, Sukehisa Nagano, Kei ichiro Takase, Taketo Hatano, Ryo Yamasaki, Jun ichi Kira

研究成果: ジャーナルへの寄稿記事

抄録

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 (ENDh) or ischemic (ENDi) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with ENDh and ENDi 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 ENDh (3.0%) and 57 ENDi (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 ENDh. 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 ENDi. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.

元の言語英語
ジャーナルJournal of Thrombosis and Thrombolysis
DOI
出版物ステータス受理済み/印刷中 - 1 1 2019

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Tissue Plasminogen Activator
Stroke
Odds Ratio
Confidence Intervals
Tomography
National Institutes of Health (U.S.)
Alberta
Multivariate Analysis
Arteries
Magnetic Resonance Imaging
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hematology
  • Cardiology and Cardiovascular Medicine

これを引用

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator. / Tanaka, Koji; Matsumoto, Shoji; Furuta, Konosuke; Yamada, Takeshi; Nagano, Sukehisa; Takase, Kei ichiro; Hatano, Taketo; Yamasaki, Ryo; Kira, Jun ichi.

:: Journal of Thrombosis and Thrombolysis, 01.01.2019.

研究成果: ジャーナルへの寄稿記事

@article{14f0e016e2c14a7889dd06c34649d189,
title = "Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator",
abstract = "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 (ENDh) or ischemic (ENDi) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with ENDh and ENDi 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 ENDh (3.0{\%}) and 57 ENDi (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 ENDh. 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 ENDi. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.",
author = "Koji Tanaka and Shoji Matsumoto and Konosuke Furuta and Takeshi Yamada and Sukehisa Nagano and Takase, {Kei ichiro} and Taketo Hatano and Ryo Yamasaki and Kira, {Jun ichi}",
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T1 - Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

AU - Tanaka, Koji

AU - Matsumoto, Shoji

AU - Furuta, Konosuke

AU - Yamada, Takeshi

AU - Nagano, Sukehisa

AU - Takase, Kei ichiro

AU - Hatano, Taketo

AU - Yamasaki, Ryo

AU - Kira, Jun ichi

PY - 2019/1/1

Y1 - 2019/1/1

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