Efficacy and Safety of Thrombolytic Therapy in Mongolian Young Adults with Acute Ischemic Stroke
DOI:
https://doi.org/10.24079/cajms.2023.06.005Keywords:
Ischemic stroke, Treatment Outcome, Tissue Plasminogen Activator, Safety, Young AdultAbstract
Objectives: The study aimed to assess the safety and efficacy of intravenous thrombolysis (IVT) in Mongolian young patients with acute ischemic stroke (AIS).
Methods: Data of 30 AIS patients aged <50 years who were treated with IVT between 2013 and 2023 at the Stroke Department of Third Central Hospital were retrospectively analyzed. For outcome comparison, 60 controls with AIS not treated with IVT and 60 older controls (>50 years) treated with IVT matched age, gender and baseline NIHSS score were selected. Functional outcome at three (3) months defined as “Favorable” and “Unfavorable” (modified Rankin Scale score 0-1 vs 2-6). Symptomatic intracerebral hemorrhage (sICH) was defined according to the SITS-MOSTStudy.
Results: “Favorable” outcome at 3 months was significantly higher in young IVT-treated patients (53.3% vs 30.0%, p < 0.05) compared with their matched young and older controls treated with IVT (53.3% vs 26.7%, p = 0.019). The sICHoccurred in 3% of young IVT-treated patients and in 5% of older controls but this difference was nonsignificant. Mortality rate was 21.7% (p = 0.245) among older controls, whereas in young IVT-treated and matched young controls 10% during the 3months follow-up.
Conclusions: IVT is safe and beneficial for Mongolian young adults with AIS.
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References
Boot E, Ekker MS, Putaala J, et al. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91(4):411-417. https://doi.org/10.1136/jnnp-2019-322424 PMid:32015089
Kissela BM, Khoury JC, Alwell K, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79:1781-7. https://doi.org/10.1212/WNL.0b013e318270401d PMid:23054237 PMCid:PMC3475622
Béjot Y, Delpont B, Giroud M. Rising stroke incidence in young adults: more epidemiological evidence, more questions to be answered. J Am Heart Assoc. 2016;5. https://doi.org/10.1161/JAHA.116.003661 PMid:27169549 PMCid:PMC4889213
Tibæk M, Dehlendorff C, Jorgensen HS, et al. Increasing incidence of hospitalization for stroke and transient ischemic attack in young adults: A Registry-Based study. J Am Heart Assoc. 2016;5. https://doi.org/10.1161/JAHA.115.003158 PMid:27169547 PMCid:PMC4889186
Jacob MA, Ekker MS, Allach Y, Cai M, Aarnio, et al. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative. Neurology. 2022 Feb 8;98(6): e573-e588. https://doi.org/10.1212/WNL.0000000000013195 PMid:34906974 PMCid:PMC8829964
Delgermaa TS, Tsagaankhuu G, Tuvshinjargal D, Baigalmaa G, Tovuudorj A. Comparative study of ischemic stroke in patients aged above and below 50 years admitted to a tertiary care hospital in Ulaanbaatar. Cent Asian J Med Sci. 2016; 2(2): 143-52. https://pdf.medrang.co.kr/CAJMS/2016/002/CAJMS002-02-05.pdf https://doi.org/10.24079/cajms.2016.02.005
Martínez-Sánchez P, Díez-Tejedor E, Fuentes B, et al. Systemic reperfusion therapy in acute ischemic stroke. Cerebrovasc Dis. 2007;24Suppl(1):143-52. https://doi.org/10.1056/NEJMoa0804656 PMid:18815396
Hacke W, Kaste M, Bluhmki E et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29. https://doi.org/10.1016/S0140-6736(98)08020-9 PMid:9788453
Reuter B, Gumbinger C, Sauer T, et al. Stroke Working Group of Baden-Wuerttemberg. Intravenous Thrombolysis is Effective in Young Adults: Results from the Baden-Wuerttemberg Stroke Registry. Front Neurol. 2015(4);6:229. https://doi.org/10.3389/fneur.2015.00229 PMid:26581808 PMCid:PMC4631948
Anzini A, Niaz A, Durastanti L, Wahlgren N, Prencipe M, Toni D. Thrombolysis in young patients: the SITS-MOST data. Cerebrovasc Dis. 2008;25(suppl 2):3. https://doi.org/10.1161/STROKEAHA.108.541185 PMid:19372446
Putaala JL, Metso AJ, Metso TM et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009 Apr;40(4):1195-203. https://doi.org/10.1161/STROKEAHA.108.529883 PMid:19246709
Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947. https://doi.org/10.1161/STR.0b013e318284056a PMid:23370205
Mohamed S, Ghaffar S, Adel E, Emad L. Short-term outcome in ischemic stroke patients after thrombolytic therapy. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):1-8. https://doi.org/10.1186/s41983-020-00251-7
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt PA Stroke Study Group. N Engl J Med. 1995; 333:1581 7. https://doi.org/10.1056/NEJM199512143332401 PMid:7477192
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35 41. https://doi.org/10.1161/01.STR.24.1.35 PMid:7678184
Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46:660 2. https://doi.org/10.1001/archneur.1989.00520420080026 PMid:2730378
Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. https://doi.org/10.1161/STR.0b013e318284056a PMid:23370205
Putaala J, Metso TM, Metso AJ, et al. Thrombolysis in young adults with ischemic stroke. Stroke. 2009;40(6): 2085-91. https://doi.org/10.1161/STROKEAHA.108.541185 PMid:19372446
Emiley P. Intravenous thrombolysis in young stroke patients: Results from the SITS-ISTR. Neurology. 2012;78:880-7. https://doi.org/10.1212/WNL.0b013e31824d966b PMid:22402853
Reuter B, Gumbinger C, Sauer T, et al. Intravenous thrombolysis is effective in young adults: Results from the baden-wuerttemberg stroke registry. Front Neurol. 2015;6: 229. https://doi.org/10.3389/fneur.2015.00229 PMid:26581808 PMCid:PMC4631948
Norby KE, Siddiq F, Adil MM, Chaudhry SA, Qureshi AI. Long term outcomes of post-thrombolytic intracerebral hemorrhage in ischemic stroke patients. Neurocrit Care. 2013; 18(2):170-7. https://doi.org/10.1007/s12028-012-9803-0 PMid:23212243
Mustanoja S, Haapaniemi E, Putaala J, et al. Haemorrhagic transformation of ischemic stroke in young adults. Int J Stroke. 2014; 9(Suppl A100):85-92. https://doi.org/10.1111/j.1747-4949.2012.00904.x PMid:23013222
Group TNTSS. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke. 1997;28(11):2109-18. https://doi.org/10.1161/01.STR.28.11.2109 PMid:9368550
Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II). Second EuropeanAustralasian Acute Stroke Study Investigators. Lancet. 1998; 352(9136): 1245-51. https://doi.org/10.1016/S0140-6736(98)08020-9 PMid:9788453
Asuzu D, Nystrom K, Amin H, et al. TURN: A simple predictor of symptomatic intracerebral hemorrhage after iv thrombolysis. Neurocrit Care. 2015;23(2):166-71. https://doi.org/10.1007/s12028-015-0131-z PMid:25869481
Toni D, Ahmed N, Anzini A, et al. Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR. Neurology. 2012;78(12):880-7. https://doi.org/10.1212/WNL.0b013e31824d966b PMid:22402853
Strbian D, Meretoja A, Ahlhelm FJ, Pitkäniemi J, Lyrer P, Kaste M, et al. Predicting outcome of IV thrombolysis treated ischemic stroke patients: The DRAGON score. Neurology. 2012;78:427 32. https://doi.org/10.1212/WNL.0b013e318245d2a9 PMid:22311929
Zhang R, Liu H, Pu L, Zhao T, Zhang S, Han K, Han L. Global Burden of Ischemic Stroke in Young Adults in 204 Countries and Territories. Neurology. 2023 Jan 24;100(4): e422-e434. https://doi.org/10.1212/WNL.0000000000201467
Papavasileiou V, Goldstein LB. Thrombolysis in young adults with acute ischemic stroke: Quicker may be better. Neurology. 2019Jun11;92(24):1129-1130. https://doi.org/10.1212/WNL.0000000000007651 PMid:31092623
Dodds JA, Xian Y, Sheng S, et al. Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke. Neurology. 2019 Jun 11;92(24):e2784-e2792. https://doi.org/10.1212/WNL.0000000000007653 PMid:31092622
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