Factors Associated With Early Neurological Deterioration After Intravenous Thrombolysis With Alteplase In Patients With Acute Ischemic Stroke

Objectives Known as recombinant tissue plasminogen activator(r-t PA),alteplase is the first and the only FDA-approved medication indicated for the treatment of acute ischemic stroke(AIS).However,quite a number of patients experience early neurological deterioration(END)and this counteracts the benefits from intravenous thrombolysis(IVT)with alteplase.The purpose of this study was to investigate the risk factors of END after IVT in patients with AIS.Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with intravenous alteplase within 4.5 hours of symptom onset.Post-IVT END was recorded and defined as a neurological deterioration of ?4 points on the National Institutes of Health Stroke Scale(NIHSS)from baseline to 24 hours after IVT or leading to death.Risk factors of END were analyzed using multivariate Logistic regression model.Results Of 220 patients enrolled in this study,34(15.5%)experienced END.Multivariate Logistic regression analysis showed that END after IVT was associated with age(increased by every 10 years: odds ratio(OR)=1.963,95% confidence interval(CI)=1.067–3.614),admission blood glucose(increased by every 1 mmol/L: OR=1.409,95% CI=1.191–1.667),leucocyte count(increased by every 1×109/L: OR=1.197,95% CI=1.018–1.409),baseline NIHSS score(increased by every 1 point: OR=1.267,95% CI=1.091–1.475),dysphagia(OR=4.312,95% CI=1.131–16.435),coma(OR=22.314,95% CI=1.385–359.505),large vessel occlusion(OR=11.739,95% CI=2.600–52.999)and cardioembolism as one of the categories from TOAST classification(OR=3.671,95% CI=1.090–12.367).These are the independent risk factors of END.Conclusions Age,admission blood glucose,leucocyte count,baseline NIHSS score,dysphagia,coma,large vessel occlusion and cardioembolism as one of the categories from TOAST classification could help predict END in AIS patient treated with IVT.For patients with these risk factors,neurologists need to strengthen communication with them before IVT therapy and alteplase should be cautiously used.Close neurological monitoring of patients at risk is also necessary for detecting abnormalities promptly and proper management(early ‘bridging' endovascular therapy for instance)in time.