Patients with Diabetes and Prior Stroke Benefit from Thrombolytic Therapy for Treatment of Acute Stroke
This finding will expand eligibility for thrombolysis in the U.S.
Concomitant diabetes mellitus and prior stroke is thought to potentially mitigate the benefits of thrombolytic therapy for acute stroke. In Europe, concomitant diabetes and prior stroke is considered a contraindication to thrombolytic therapy, whereas in the U.S., it is considered a contraindication only for patients who present in the expanded treatment window (3 4.5 hours).
Researchers used registry data to assess the effect of diabetes and prior stroke on outcomes (adjusted 90-day modified Rankin Scale score) in patients who received tissue plasminogen activator (TPA) for acute stroke (data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register) and control patients who did not (data from the Virtual International Stroke Trials Archive). Analyses were controlled for the following confounding patient variables: National Institutes of Health Stroke Scale score, age, and comorbidities.
Of 29,500 patients, 19% had diabetes, 17% had prior stroke, and 6% had both. Among patients with diabetes, prior stroke, or both, those who received TPA had significantly better outcomes than those who did not receive TPA. Among patients who received TPA, those with diabetes, prior stroke, or both had similar outcomes to those with neither diabetes nor prior stroke.
Comment: This large study does not support excluding patients with diabetes mellitus, prior stroke, or both from consideration for thrombolytic therapy for treatment of acute stroke. This finding will expand eligibility for thrombolytic therapy.
Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine November 18, 2011