12 research outputs found
Early outcome after intravenous thrombolysis in patients with acute ischemic stroke
Background : Patients with acute ischemic stroke who had early
neurological improvement had better functional outcome. The purpose of
this study was to determine factors associated with early clinical
improvement and early worsening in patients with acute ischemic stroke
treated with intravenous thrombolysis. Patients and Methods : Patients
treated with intravenous recombinant tissue plasminogen activator
(rtPA) between August 2008 and November 2010 were the subjects of this
study. Early improvement was defined by marked, clinical improvement or
complete recovery at 24 h (National Institutes of Health Stroke Scale
(NIHSS) 0-4 at 24 h). Early worsening was defined by an increase in
NIHSS ≥1 from baseline. The baseline characteristics were
compared between patients with and without outcome of interest.
Results : Of the 203 patients studied, 19 (9.4%) patients had complete
recovery and 68 (33.5%) patients had marked clinical improvement (NIHSS
1-4) at 24 h. Most patients with early clinical improvement (86%) had
favorable outcome at three months. Of the 22 (10.8%) patients who had
early clinical worsening, only three (14%) patients achieved favorable
outcome at three months and six (29%) patients died. Multivariate
analysis revealed that older age (≥70 years old) (odd ratio (OR)
0.498, P = 0.049), severe stroke (NIHSS ≥15) (OR
0.154, P < 0.0001) and having intracerebral hemorrhage
(ICH) (OR 0.364, P = 0.032) were inversely associated with
early improvement. History of transient ischemic attack (TIA) (OR
7.724, P = 0.043) and ICH (OR 4.477, P = 0.008)
were related to early worsening. Conclusions : The presence of early
clinical improvement or worsening within 24 h after treatment with rtPA
had major impact on the outcome at three months
Stroke Outcomes in Thai Elderly Patients Treated with and without Intravenous Thrombolysis
Higher mortality was found in very old patients with acute ischemic stroke treated with intravenous recombinant tissue-plasminogen activator (rtPA) as compared to younger patients. The benefit of thrombolytic treatment in this particular subgroup is still a subject of debate. The purpose of this study was to compare stroke outcomes in Thai patients aged over 70 years treated with and without intravenous rtPA. This was a retrospective review of sequential cases and was not a randomized controlled study. One-hundred and five patients with acute ischemic stroke aged over 70 years who were treated with intravenous rtPA and 105 patients without rtPA treatment (control group) were included in the study. Patients’ base-line characteristics and study outcomes of interest were compared. There were significant differences in the base-line characteristics of the two groups. However, for the subgroup of patients aged over 80 years, these characteristics were similar. Those who were treated with intravenous rtPA had a higher rate of favorable outcomes (40% vs 16%; P=0.137) and a lower rate of mortality (22% vs 44%; P=0.128) than patients who did not receive rtPA treatment. In well-matched subgroups of patients aged over 80 years, our retrospective review revealed there was a trend of a higher rate of favorable outcome and lower mortality in patients receiving rtPA treatment. More study is needed to further confirm the suggested benefit of thrombolysis in Asian octogenarian acute stroke patients
Low vs standard dose of recombinant tissue plasminogen activator in treating East Asian patients with acute ischemic stroke
Background : Intravenous recombinant tissue plasminogen activator
(rtPA) has been approved to treat eligible patients with acute ischemic
stroke within 4.5 hours of onset. The rationale for using a lower dose
in Asian patients came from concerns about intracerebral hemorrhage
because of the racial differences in blood coagulation-fibrinolysis
factors. Aim : The aim of this systemic review was to compare the data
from previous studies to address the efficacy and safety of using
low-dose vs standard-dose rtPA in treating patients with acute ischemic
stroke. Material and Methods : Previous studies were searched and
analyzed. The confidence interval was calculated at 95%. Baseline
characteristics and outcomes of the patients were compared between two
doses of rtPA (0.6 vs 0.9 mg/kg), using Z test for two independent
proportions. Results : Patients who received standard-dose rtPA had
significantly higher favorable outcome at 3 months (33.1 vs 47.2%,
P<0.0001), without significant difference in the rates of
symptomatic intracerebral hemorrhage (3.5 vs 4.3%, P = 0.42) and
mortality (13.1 vs 11.7%, P = 0.56). However, patients in the low-dose
group were older and had more severe stroke. Conclusions : Patients
receiving standard-dose rtPA seem to have higher rates of favorable
outcome. However, there were significant differences in baseline
characteristics between the two groups. A further, well-designed,
randomized study in the same population is still needed to clarify the
suspected benefit of the standard dose for East Asian patients
Prediction of intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke using multiple artificial neural networks
Stroke outcomes in Thai elderly patients treated with and without intravenous thrombolysis
Prevalence of Cerebral Microbleeds in Thai Patients with Ischemic Stroke
Background: With the widespread use of magnetic resonance imaging (MRI), cerebral microbleeds (CMBs) are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Methods: Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January–August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Results: Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients). Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07–8.68, P = 0.037), and moderate-to-severe white matter lesions (Fazekas 2–3, OR 7.61, 95% CI 3.06–18.95, P < 0.001) were related to the presence of CMBs. Conclusions: CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions
Comparison of Computerized and Standard Cognitive Test in Thai Memory Clinic
Background: Computer-based Thai Cognitive Test or Computer-based Thai Mental State Examination (cTMSE) was developed aiming to help doctors to easily get the accurate results of TMSE in a routine, busy outpatient clinics. The purpose of this study was to compare the evaluation process in terms of feasibility, duration of the test, participants/administrator preference, and the results of cognitive test between cTMSE and the standard Thai Mental State Examination (sTMSE). Methods: Twenty-two elderly participants (>60 years old) who were not demented and 22 patients with mild-to-moderate dementia were included in the study. All participants would be asked to have TMSE by standard method (sTMSE) and computer-based method (cTMSE), at least 2 weeks and up to 2 months apart. Scores and duration of the test were compared using dependent paired t-test. Agreement of the tests between two methods and Kappa statistics were analyzed. Results: Paired t-test showed no significant difference in scores between the two methods (mean sTMSE vs. cTMSE: 22.84 vs. 22.62, 95% confidence interval [CI]: [−0.465] to 0.987, P = 0.524). Percent of agreement between the two methods was 92.5%, with the Kappa of 0.85 (P < 0.001). Duration of the test by sTMSE was slightly shorter than the cTMSE (7.31 min vs. 7.97 min, 95% CI: [−1.159] to [−0.175], P = 0.09). Overall, participants liked being tested by cTMSE more than sTMSE. Conclusion: Computer-based TMSE was feasible to use and accurate for screening in aging adults and for cognitive evaluation in patients with mild-to-moderate dementia
Feasibility and safety of remote radiology interpretation with telephone consultation for acute stroke in Thailand
"Telestroke" is emerging as a potential timesaving, efficient means for
evaluating patients experiencing acute ischemic stroke. It provides an
opportunity for administration of thrombolytic drugs within the short
therapeutic time window associated with AIS. We describe our
experiences of the feasibility and safety of remote radiology
interpretation with telephone consultation. Thammasat Stroke Center
employs a computed tomography-digital imaging and communication in
medicine (CT-DICOM) image transfer by PACS (SYNAPSE-Fujifilm),
providing a real-time CT image transferred directly to the stroke
consultants. The patient data are communicated by traditional telephone
conversation. Here, we assessed patients who received intravenous rt-PA
treatment for ASI between October 2007 and January 2009. A total of 458
patients with AIS and transient ischemic attack (TIA) were admitted to
a stroke unit during the study period. One hundred patients received
intravenous rt-PA (21%). Median NIHSS before thrombolysis was 15
(3-34). Mean door-to-needle time was 54 minutes (15-125). Mean
onset-to-treatment time OTT was 160 minutes (60-270). There were 13
asymptomatic intracerebral hemorrhages and two (one fatal) symptomatic
intracerebral hemorrhages. At 3 months, 42 patients had achieved
excellent recovery (mRS, 0-1) and 14 had died. Administration of rt-PA
for AIS with remote radiology interpretation with telephone
consultation was feasible and safe, and the system was well received.
Further studies are needed to determine the benefit of this method as
compared to the conventional telephone consultation alone