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No Effect From Pre-Existing Disability On 3-Month Function Level In Acute Stroke Patients Treated With Thrombolysis
Canadian Medical Association Journal (CMAJ)
08/07/2003
By Elda Hauschildt
Acute stroke patients with pre-existing disability who are treated with thrombolysis return to pre-stroke level of function at 3 months as often as patients without pre- existing disability, Canadian researchers report.
Investigators led by Dr. Blaine Taylor Foell of the University of Western Ontario in London, Ontario, explain acute stroke patients with pre-existing disability treated with intravenously administered tissue plasminogen activator (tPA) have a poorer outcome, in terms of both survival and function.
But, they say a study of 112 consecutive patients demonstrates there is "little difference between patients with and without pre-existing disability in the proportion at 3 months with a favourable National Institutes of Health stroke scale (NIHSS) score or a return to a good pre-stroke modified Rankin scale (MRS) score."
They say that the results show patients with pre-existing disability may benefit from intravenous (IV) tPA treatment, although they suggest further studies are needed in this patient population.
Participants all had acute ischaemic stroke, were treated with IV thrombolysis and followed for 3 months. At baseline, each was assigned an MRS score for functional disability and a NIHSS for neurological impairment. Both scores were reassessed at 3 months.
Patients were stratified into two groups: 88 without pre- existing disability and 24 (21%) with pre-existing disability. Pre-existing disability was defined as an MRS score, before stroke, of 2 or more. Baseline characteristics were similar for the two groups, except that those in the pre-existing disability group had a higher mean age and more had hypertension.
Mortality was 33% among patients with pre-existing disability. It was especially high (50%) among those with a pre-stroke MRS score of 3 to 5.
CMAJ 2003;169:193-197.
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