Pre-stroke factors (morbitities, diet, medication, demograhics) that affect the severity of a stroke

• Main Authors: Nicolas Poupore, Marvin Okon, Tristan Mackey, Thomas I. Nathaniel
• Format: Article
• Language: English
• Published: Elsevier 2021-12-01
• Series: Thrombosis Update
• Subjects: Acute ischemic stroke; Anti-hypertensive medications (anti-HTN); NIHSS score; Recombinant tissue plasminogen activator (rtPA)
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666572721000420

Background: The goal of this study is to elucidate clinical characteristics in patients with acute ischemic stroke (AIS) that are associated with a potential improvement or worsening neurologic function who previously were taking an anti-hypertensive medication and then received recombinant tissue plasminogen activator (rtPA). Methods: The binary logistical regression model was developed to identify clinical determinants that are associated with an improving or worsening neurologic function in AIS patients taking an anti-HTN medication who received thrombolytic therapy. The area under the receiver operating curve was used to determine the sensitivity of the model. Results: In the adjusted analysis for AIS population on combined rtPA and an anti-HTN medication therapy, increasing age (Odd ratio; OR = 1.035, 95% CI, 1.022–1.049, P < 0.001), female (OR = 1.630, 95% CI, 1.182–2.248, P = 0.002), and history of substance abuse (OR = 2.315, 95% CI, 1.107–4.842, P = 0.026) were associated with a worsening neurologic function. Caucasian patients (OR = 0.535, 95% CI, 0.361–0.793, P = 0.002), with the clinical presentations of dyslipidemia (OR = 0.655, 95% CI, 0.479–0.897, P = 0.008), obesity (OR = 0.642, 95% CI, 0.472–0.873, P = 0.005), HDL (OR = 0.988, 95% CI, 0.976–1.000, P = 0.045), and directedly admitted for treatment (OR = 0.509, 95% CI, 0.341–0.761, P = 0.001) were associated with improving neurologic function. In AIS who received rtPA and were not taking an anti-HTN medications, increasing age (OR = 1.021, 95% CI, 1.004–1.038, P = 0.015) and improvement in ambulation (OR = 1.762, 95% CI, 1.077–2.882, P = 0.024) were associated with a worsening neurologic function, while a direct admission (OR = 0.317, 95% CI, 0.158–0.635, P = 0.001) was correlated with progressing neurologic function. Conclusion: Our findings reveal specific demographic and clinical risk factors that are associated with worsening or improving neurological functions in AIS pretreated with an anti-HTN medication with a subsequent thrombolytic therapy. This finding suggests the development of management strategies to manage identified clinical risk factors in AIS pretreated with an anti-HTN medication prior to thrombolytic therapy.