Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: a hospital-based study from south India

Neurol India. May-Jun 2010;58(3):403-6. doi: 10.4103/0028-3886.66085.

Abstract

Background: Despite the increasing use of recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke, uncertainty persists about the short- and long-term outcome of the thrombolysed patients.

Objective: To identify predictors of major neurological improvement at 24 h after intravenous rt-PA administration in patients of acute ischemic stroke and their relationship with outcome at 12 months.

Materials and methods: We analyzed the data of the patients with acute ischemic stroke treated as per the National Institute of Neurological Disorders and Stroke (NINDS) criteria with intravenous rt-PA between January 2000 and June 2009 at a tertiary care center in south India. Major neurological improvement was defined by an 8-point improvement in National Institute of Health Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 h. Good outcome was defined as a 12-month modified Rankin Scale (mRS) of 0 to 1.

Results: Of the 72 patients with acute ischemic stroke treated with intravenous rt-PA, 23 (32%) patients had major neurological improvement at 24 h. Age <60 years (OR 1.9, 95% CI 1.7 to 3.2), admission glucose levels <8 mmol/L (OR 3.87, 95% CI 1.9 to 9.2) and mild to moderate baseline stroke severity (NIHSS median score 10+ 6) were associated with major neurological improvement after adjusting for co variables. Major neurological improvement at 24 h was an independent predictor of good outcome (mRS=1) at 12 months (OR 13.9, 95% CI 6.84 to 40.2).

Conclusions: Age <60 years, glucose levels <8 mmol/L and mild to moderate stroke severity (NIHSS median score 10+/-6) was associated with major neurological improvement after intravenous rt-PA. Major neurological improvement at 24 h after the administration of intravenous thrombolysis independently predicted good outcome at 12 months.

MeSH terms

  • Adult
  • Aged
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Hospitals / statistics & numerical data
  • Humans
  • India / epidemiology
  • Injections, Intravenous / methods
  • Ischemia / classification
  • Male
  • Middle Aged
  • Nervous System Diseases / drug therapy*
  • Nervous System Diseases / etiology*
  • Odds Ratio
  • Predictive Value of Tests
  • Retrospective Studies
  • Stroke / complications*
  • Stroke / epidemiology
  • Stroke / etiology
  • Time Factors
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome
  • Young Adult

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator