title: Sulfonylurea Pretreatment and In-Hospital Use Does Not Impact Acute Ischemic Strokes (AIS) Outcomes Following Intravenous Thrombolysis.
abstract: OBJECTIVE
  Preliminary studies have indicated that sulfonylurea drugs (SUD) may confer protection against cerebral swelling and hemorrhagic transformation in severe acute ischemic stroke (AIS). We sought to determine whether pretreatment and in-hospital use of SUD may be associated with better outcomes in diabetic AIS patients treated with intravenous thrombolysis (IVT).
  
  
  METHODS
  We analyzed consecutive diabetic AIS patients treated with IVT during a 3-year period. Pretreatment with SUD, admission NIHSS (National Institutes of Health Stroke Scale) score, NIHSS at 48 hours, and modified Rankin Scale (mRS) at discharge were documented. Patients who discontinued SUD during hospitalization were excluded. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH with NIHSS score increase of greater than or equal to 4 points within 72 hours. Early neurological improvement was defined as an NIHSS score decrease of greater than or equal to 4 points or NIHSS score of 0 at 48 hours. Cerebral edema was documented by neuroradiology reports. Favorable functional outcome (FFO) was defined as discharge mRS of 0-1.
  
  
  RESULTS
  A total of 148 diabetic AIS patients were evaluated (mean age 64 ± 11 years, 49% men, median admission NIHSS score: 8 points). We identified 42 (28%) cases pretreated with SUD. The prevalence of complications and favorable outcomes did not differ (P > .1) between patients pretreated and nonpretreated with SUD: sICH (2% versus 5%), cerebral edema (5% versus 4%), early neurological improvement (42% versus 43%), in-hospital mortality (12% versus 5%), and FFO (22% versus 32%).
  
  
  CONCLUSIONS
  Pretreatment and in-hospital use of SUD appears not to be associated with early favorable outcomes and lower likelihood of potential complications in diabetic AIS patients treated with IVT.
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ngoyal@uthsc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Iftikhar
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Ramin
authors.initials: R
authors.lastname: Zand
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Australian Catholic University, Sydney, New South Wales, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Malkoff
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013453:Sulfonylurea Compounds
keywords: Intravenous thrombolysis; cerebral edema; favorable outcome; safety; strokes; sulfonylurea