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. 2014 Feb 12;9(2):e88652.
doi: 10.1371/journal.pone.0088652. eCollection 2014.

Predictors of critical care needs after IV thrombolysis for acute ischemic stroke

Roland Faigle  1 , Anjail Sharrief  2 , Elisabeth B Marsh  1 , Rafael H Llinas  1 , Victor C Urrutia  1
Affiliations

Predictors of critical care needs after IV thrombolysis for acute ischemic stroke

Roland Faigle et al. PLoS One. .

Abstract

Background and purpose: Intravenous (IV) tissue plasminogen activator (tPA) is the only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke. Post tPA patients are typically monitored in an intensive care unit (ICU) for at least 24 hours. However, rigorous evidence to support this practice is lacking. This study evaluates factors that predict ICU needs after IV thrombolysis.

Methods: A retrospective chart review was performed for 153 patients who received intravenous tPA for acute ischemic stroke. Data on stroke risk factors, physiologic parameters on presentation, and stroke severity were collected. The timing and nature of an intensive care intervention, if needed, was recorded. Using multivariable logistic regression, we determined factors associated with requiring ICU care.

Results: African American race (Odds Ratio [OR] 8.05, 95% Confidence Interval [CI] 2.65-24.48), systolic blood pressure, and National Institutes of Health Stroke Scale (NIHSS) (OR 1.20 per point increase, 95% CI 1.09-1.31) were predictors of utilization of ICU resources. Patients with an NIHSS≥10 had a 7.7 times higher risk of requiring ICU resources compared to patients who presented with an NIHSS<10 (p<0.001). Most patients with ICU needs developed them prior to the end of tPA infusion (81.0%, 95% CI 68.8-93.1). Only 7% of patients without ICU needs by the end of the tPA infusion went on to require ICU care later on. These patients were more likely to have diabetes mellitus and had significantly higher NIHSS compared to patients without further ICU needs (mean NIHSS 17.3, 95% CI 11.5-22.9 vs. 9.2, 95% CI 7.7-9.6).

Conclusion: Race, NIHSS, and systolic blood pressure predict ICU needs following tPA for acute ischemic stroke. We propose that patients without ICU needs by the end of the tPA infusion might be safely monitored in a non-ICU setting if NIHSS at presentation is low.

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Conflict of interest statement

Competing Interests: Victor C. Urrutia has read the journal's policy and has the following conflicts: 1. PI for the investigator initiated trial SAIL ON (a pilot clinical trial of IV tPA treatment for patients that wake up with stroke). Genentec Inc. has provided funding for this trial. 2. PI at Johns Hopkins for the multicenter clinical trial DIAS 4. Sponsor is Lundbeck. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. ICU needs by NIHSS after IV tPA. A scatter plot is shown illustrating the percentage of patients requiring ICU care by NIHSS at presentation.
Figure 2
Figure 2. Timing of ICU needs after IV tPA. A flowchart is shown illustrating the need for critical care interventions over time in all patients receiving IV tPA.
See this image and copyright information in PMC

References

    1. Mensah GA, Mendis S, Greenland K, MacKay J (2004) The atlas of heart disease and stroke. World Health Organization
    1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, et al. (2010) Executive summary: Heart disease and stroke statistics–2010 update: A report from the american heart association. Circulation 121: 948–954. - PubMed
    1. Demaerschalk BM, Hwang HM, Leung G (2010) US cost burden of ischemic stroke: A systematic literature review. Am J Manag Care 16: 525–533. - PubMed
    1. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, et al. (2011) Heart disease and stroke statistics–2011 update: A report from the american heart association. Circulation 123: e18–e209. - PMC - PubMed
    1. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, et al. (2004) Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363: 768–774. - PubMed

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