Safety and Efficacy of Intravenous Thrombolysis in the 3- to 4.5-hour Window in Acute Ischemic Stroke Patients Who Have Both Diabetes Mellitus and History of Prior Stroke
- Author:
Boyoung KIM
1
;
Ji Sung LEE
;
Hong-Kyun PARK
;
Young Bok YUNG
;
Ki Chang OH
;
Jeong Joo PARK
;
Yong-Jin CHO
;
Kyusik KANG
;
Soo Joo LEE
;
Jae Guk KIM
;
Jae-Kwan CHA
;
Dae-Hyun KIM
;
Hee-Joon BAE
;
Tai Hwan PARK
;
Sang-Soon PARK
;
Kyung Bok LEE
;
Jun LEE
;
Byung-Chul LEE
;
Minwoo LEE
;
Joon-Tae KIM
;
Kang-Ho CHOI
;
Dong-Eog KIM
;
Jay Chol CHOI
;
Dong-Ick SHIN
;
Jee-Hyun KWON
;
Wook-Joo KIM
;
Sung Il SOHN
;
Jeong-Ho HONG
;
Hyung Jong PARK
;
Seong-Hwa JANG
;
Kwang-Yeol PARK
;
Sang-Hwa LEE
;
Jong-Moo PARK
;
Keun-Sik HONG
Author Information
- Publication Type:Original Article
- From:Journal of the Korean Neurological Association 2023;41(2):112-120
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Background:For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients.
Methods:Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927).
Results:The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]).
Conclusions:In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.
