Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jan 2014
Predictors of in-hospital mortality and the risk of symptomatic intracerebral hemorrhage after thrombolytic therapy with recombinant tissue plasminogen activator in acute ischemic stroke.
Recombinant tissue-plasminogen activator (rt-PA) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sICH). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 ± 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 ± 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. ⋯ After rt-PA therapy, 58 patients (5.8%) sustained sICH, 16 (28%) of whom died. Increased age (P = .008), higher NIHSS score (P = .011), and atrial fibrillation (P = .025) were correlated with sICH. The findings from this study may help clinicians estimate the prognosis and risk of sICH in patients with AIS treated with rt-PA.
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J Stroke Cerebrovasc Dis · Jan 2014
Race and income disparity in ischemic stroke care: nationwide inpatient sample database, 2002 to 2008.
Health care disparities exist between demographic groups with stroke. We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care. ⋯ African Americans, Hispanics, and low median income patients are less likely to receive i.v. thrombolysis for ischemic stroke. Low median income patients are less likely to be treated at high-volume hospitals. High-volume hospitals have lower mortality rates and a higher likelihood of treating patients with i.v. thrombolysis. There is evidence for an influence of socioeconomic status and racial disparity in the treatment of ischemic stroke.
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J Stroke Cerebrovasc Dis · Jan 2014
Early neurologic improvement based on the National Institutes of Health Stroke Scale score predicts favorable outcome within 30 minutes after undergoing intravenous recombinant tissue plasminogen activator therapy.
The aim of the present study was to evaluate whether early neurologic improvement (within 30 minutes), as measured using the National Institutes of Health Stroke Scale (NIHSS) score, predicts favorable outcome at 90 days. ⋯ An improvement of at least 3 points in the NIHSS score at 15 minutes or of at least 5 points at 30 minutes appears to be a predictor of favorable outcome and helps to identify patients who will not respond to rt-PA therapy.
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J Stroke Cerebrovasc Dis · Jan 2014
Venous thromboembolism in the Get With The Guidelines-Stroke acute ischemic stroke population: incidence and patterns of prophylaxis.
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), represents a serious complication in hospitalized ischemic stroke patients. This study examines the incidence of VTE and the patterns of VTE prophylaxis in acute ischemic stroke patients deemed appropriate for VTE prophylaxis (nonambulatory) in the Get With The Guidelines-Stroke (GWTG-S) study. ⋯ Despite a high overall rate of VTE prophylaxis, VTE was found to occur in approximately 3% of GWTG-S patients. Reported rates of VTE prophylaxis differed among hospitals by region and hospital type, and among patients by age, race, and medical comorbidities.
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J Stroke Cerebrovasc Dis · Jan 2014
Acute kidney injury is associated with increased hospital mortality after stroke.
Acute kidney injury (AKI) is common and is associated with poor clinical outcomes. Information about the incidence of AKI and its effect on stroke outcomes is limited. ⋯ AKI occurs frequently after stroke and is associated with increased hospital mortality. Additional studies are needed to establish if the association is causal and if measures to prevent AKI would result in decreased mortality.