PREDICTORS OF CLINICAL OUTCOME AFTER INTRAVENOUS STROKE THROMBOLYSIS: A PROSPECTIVE STUDY FROM SOUTH INDIA
1 Sateesh Gudla
2 S.V.Naveen Prasad
3 Bhuma Vengamma
4 Ramachandiran Nandhagopal
Intravenous thrombolysis within window period has been well established as the standard-of-care treatment for acute ischemic stroke. However, the factors influencing clinical outcome have not been well studied in resource-poor settings for mechanical thrombectomy. Objective: To analyze the predictors of clinical outcome of stroke subjects who received intravenous thrombolysis at Sri Venkateswara Institute of Medical Sciences, a university teaching hospital in South India.
MATERIAL and METHOD:
We prospectively studied the demographic profile, stroke characteristics, window period, door to needle time, thrombolytic agent (alteplase vs. tenecteplase) administered, hemorrhagic complication and modified Rankin scale (mRS) score in 74 acute ischemic stroke subjects during the study period from May 2019 to October 2020. A favourable outcome was defined as mRS score of 0 to 2 at 90 days. The factors influencing the clinical outcome were analyzed using multivariate regression analysis.
Our prospective stroke cohort consisted of 55 men (74%) and 19 women(26%), aged 56.2±12.3 years, who presented with a median NIH stroke scale score of 10, within 165.2±73.2 minutes of stroke onset. Twenty nine patients (39.2%) received intravenous alteplase, while forty five subjects (60.8%) had tenecteplase within door-to-needle time of 76 ± 28.7 minutes. A favourable clinical outcome was observed in 46 subjects (69.7%). There was no difference in the clinical outcome between those who received alteplase vs. tenecteplase. Symptomatic intracerebral hemorrhage was observed in 1 subject; 2 patients had anaphylaxis with tenecteplase; and 8 patients died (overall). Multivariate regression analysis revealed respiratory insufficiency (requiring mechanical ventilatory support) as the significant independent predictor of unfavourable clinical outcome.
This prospective study of stroke thrombolysis revealed similar clinical outcome between those patients who received alteplase vs. tenecteplase in the real life scenario. Respiratory impairment requiring ventilatory assistance emerged as the independent predictor of unfavourable clinical outcome following thrombolytic therapy.