Predictors of Failure of Neurological Improvement in Patients with Acute Ischemic Stroke after Thrombolytic Therapy
Keywords:
Acute ischemic stroke, Poor neurological recovery, Thrombolytic drugsAbstract
The administration of rtPA thrombolytic drugs within 4.5 hours of stroke onset is the recommended treatment for acute ischemic stroke; however, neurological recovery is not achieved in some patients. Thus, the objective of this study was to study factors affecting neurological recovery in order to provide recommendations for the formulation of a treatment plan and treatment guidelines. This retrospective cohort study was performed using the medical records of 267 patients with acute ischemic stroke who were treated with thrombolytic drugs and attended the emergency room at Saraburi Hospital between October 1, 2015 and September 30, 2021. Statistical analysis was then performed using Chi square test or Fisher’s exact test, t-test, and multivariable logistic regression analysis.
The results revealed that factors affecting neurologic recovery in the patients were blood glucose > 110 mg/dL with an odd ratio of 2.04 (95%CI 1.04,4.03, p= 0.039), abnormalities in CT Brain including small infarction with an odd ratio of 2.73 (95%CI 1.53,6.16, p= 0.010), and large vessel occlusion with an odd ratio of 5.34 (95%CI 2.52, 11.33, p= <0.001).
Development of a patient care system especially correct CT Brain interpretation can determine whether thrombolytic drugs or treatment options would be effective. For example, if CT Brain reveals large vessel occlusion, mechanical thrombectomy may be considered. In addition, a blood glucose level of higher than 110 mg/dL may result in poor neurological recovery in patients with acute ischemic stroke.
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