title: Intravenous Thrombolysis Attenuates Neurologic Deterioration After Ischemic Stroke.
abstract: Although intravenous tissue plasminogen activator (IV tPA) is associated with neurologic deterioration (ND) caused by hemorrhage, whether it attenuates deterioration as a result of other etiologies including progressive stroke remains unexplored. The objective of this study was to determine whether IV tPA is associated with a reduced risk of ND caused by progressive stroke.
  
  
  
  A retrospective investigation of consecutively admitted patients with acute ischemic stroke (July 2008-June 2014) within 4.5 hours of symptom onset was conducted at a tertiary care center. Patients treated with IV tPA were compared with those who were not. The primary outcome was ND resulting from progressive infarction (a two-point increase in the National Institutes of Health Stroke Scale score during a 24-hour period).
  
  
  
  A total of 699 registry patients (median age 65 years, interquartile range 55-76, 48.4% women, 70.4% nonwhite) were included in the study, and 58.1% received IV tPA. In crude regression, IV tPA did not reduce the odds of ND caused by progressive infarction; however, IV tPA-treated patients were at a 55% lower odds of ND from any cause (odds ratio 0.45, 95% confidence interval 0.32-0.61,P< 0.001). After adjusting for covariates, IV tPA use remained strongly associated with a 39% lower odds of ND from any cause (odds ratio 0.61, 95% confidence interval 0.48-0.79,P< 0.001).
  
  
  
  Although IV tPA did not correlate with a reduced odds of progressive infarction, it was significantly associated with a lower odds of ND by any mechanism.
authors.affiliation: From the Department of Neurology, Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, Louisiana.
authors.forename: James E
authors.initials: JE
authors.lastname: Siegler
authors.affiliation: From the Department of Neurology, Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, Louisiana.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000517:prevention & control*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator