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


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.
Boddu
Demudu Babu
DB
Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad 500 082, India.
Srinivasarao Bandaru
V C S
VC
Reddy
Prasad G
PG
Madhusudan
M
M
Rukmini
M K
MK
Suryaprabha
T
T
Jabeen
S A
SA
Suvarna
A
A
Jayalakshmi
Sita S
SS
Meena
A K
AK
Borgohain
Rupam
R
Kaul
Subhash
S
D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007275:Injections, Intravenous / Q000379:methods; D007511:Ischemia / Q000145:classification; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator