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Research article
Thomas Nathaniel
University of South Carolina School of Medicine Greenville Campus
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0954-5050
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Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.
Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.
Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.
Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.
Keywords
Ischemic, stroke, trans ischemic attack, clinical risk factors, thrombolytic therapy
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Editor invited
On 23 Jan, 2020
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Editorial decision: Minor revision
On 30 Dec, 2019
Review #1 received
Received 28 Dec, 2019
Review #2 received
Received 28 Dec, 2019
Reviewer #2 agreed
On 27 Dec, 2019
Reviewer #1 agreed
On 09 Dec, 2019
Reviewers invited
Invitations sent on 23 Nov, 2019
Editor invited
On 07 Nov, 2019
Editor assigned
On 25 Oct, 2019
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Subject Areas
Neurosurgery
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See the published version of this preprint at BMC Neurology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Thomas Nathaniel
University of South Carolina School of Medicine Greenville Campus
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0954-5050
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Neurology.
No community comments so far
Editor assigned
On 09 Mar, 2020
Submission checks complete
On 08 Mar, 2020
Editor invited
On 08 Mar, 2020
Version 2
Posted 27 Jan, 2020
No comments provided
Review #2 received
Received 05 Mar, 2020
Editorial decision: Major revision
On 05 Mar, 2020
Reviewer #2 agreed
On 17 Feb, 2020
Review #1 received
Received 12 Feb, 2020
Reviewer #1 agreed
On 10 Feb, 2020
Reviewers invited
Invitations sent on 09 Feb, 2020
Editor assigned
On 24 Jan, 2020
Submission checks complete
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 30 Dec, 2019
Review #1 received
Received 28 Dec, 2019
Review #2 received
Received 28 Dec, 2019
Reviewer #2 agreed
On 27 Dec, 2019
Reviewer #1 agreed
On 09 Dec, 2019
Reviewers invited
Invitations sent on 23 Nov, 2019
Editor invited
On 07 Nov, 2019
Editor assigned
On 25 Oct, 2019
First submitted
On 24 Oct, 2019
Submission checks complete
On 24 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurosurgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Neurology.
Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.
Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.
Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.
Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.
Figure 1
Figure 2
Figure 3
Figure 4
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