A retrospective pilot study analyzing the effects of various factors and benefits of various drugs used in treating late admitted cases of acute ischemic stroke
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20160769Keywords:
Retrospective pilot study, Acute ischemic stroke, Neurological deficitAbstract
Background: In Indian scenario, most of the cases of acute ischemic stroke are admitted and initiated treatment when the stipulated period of 4-6h for thrombolytic therapy is crossed. It is unclear on to benefits of treating such patients and our study aims at analysing the clinical and demographic factors associated with achieving improvement in functional ability in this special category of patients.
Methods: Review of case records of acute ischemic stroke patients admitted after 6h of onset of stroke to a tertiary care teaching hospital of north Karnataka, India, over a period of one year with minimum of seven days of treatment was done. Drug utilization pattern, severity of ischemic stroke, baseline demographic and clinical data were extracted. The neurological recovery at the end of treatment period was analysed by using Barthel Index (BI) score. All the factors and drug utilization pattern were described using descriptive statistics and their correlation with BI score was analysed by spearman’s correlation coefficient.
Results: Of the total 446 case records with diagnosis of stroke, only 39 met the eligibility criteria and included in the study. Statistically significant correlation to BI score was seen with severity of stroke, day-1 SBP, use of physiotherapy, time lapsed in initiating treatment, amount of decrease in SBP and baseline serum creatinine level.
Conclusions: Our study helped in generating the hypothesis on effects of various factors and therapeutic modalities on neurological recovery of late admitted cases of acute ischemic stroke.
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References
Sims NR, Muyderman H. Mitochondria, oxidative metabolism and cell death in stroke. Biochimica et Biophysica Acta. 2009;1802:80-91.
Gupta R, Joshi P, Mohan V, Reddy S, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94:16-26.
Edward CJ, Brian S. Ischemic Stroke Medication. Medscape: drugs and diseases, 2015. Available at http://emedicine.medscape.com/article/1916852-medication#showall. Accessed 28 December 2015.
Edward CJ, Brian S. Ischemic Stroke Treatment & Management. Medscape drugs and diseases. 2015. http://emedicine.medscape.com/article/196852-treatment#aw2aab6b6b4. Accesses 28 December 2015.
Howard SK, José B, Alfred SC. Long-Term Therapy to Prevent Stroke. J Am Board Fam Med. 2005;18:528-40.
Wang H, Tang Y, Rong X, Li H, Pan R. Effects of Early Blood Pressure Lowering on Early and Long-Term Outcomes after Acute Stroke: An Updated Meta-Analysis. PLoS ONE. 2014;9:e97917.
Jeffery LS. Targeting the Brain: Neuroprotection and Neurorestoration in Ischemic Stroke Pharmacotherapy. 2010;30:S62-9.
Kiyoshi K, Hisaaki U, Motohiro M, Yoshinaka M, Elichiro T. Clinical Neuroprotective Drugs for Treatment and Prevention of Stroke. Int. J. Mol. Sci. 2012;13:7739-61.
Helmi LL, Wayne MC. Neuroprotective Agents in Stroke- Overview of Neuroprotective Agents. Medscape drugs and diseases. 2015. Available at http://emedicine.medscape.com/article/1161422-overview#a30. Accessed 28 December 2015.
Diener HC. Primary and secondary stroke prevention with antiplatelet drugs. Curr Pharm Des. 2006;12:1293-7.
Lian Z, Stan H, Philip MW. Antiplatelet Therapy for Stroke Prevention. Br J Cardiology. 2005;12:57-60.
Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC. American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46:3020-35.
Sankapithilu GB, Nagaraj V, Khan MA. A study of
factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario. Online Journal of Health and Allied Sciences. 2010;9:1-4.
Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999;30:1538-41.
Ovbiagele B, Saver JL. Day-90 acute ischemic stroke outcomes can be derived from early functional activity level. Cerebrovasc Dis. 2010;29:50-6.
Helseth EK. Posterior Cerebral Artery Stroke. 2015. Available at http://emedicine.medscape.com/article/2128100-overview#a7. Accessed 30 December 2015.
National Institutes of Health Stroke Scale, 2015. Available at https://en.wikipedia.org/ wiki/National_Institutes_of_Health_Stroke_Scale. Accessed 30 December 2015.
Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malwi medical Journal. 2012;24(3):69-71.
Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118:176-87.
Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database of Systematic Reviews 2014;4:CD001920.
Kasner SE, Cucchiara BL, McGarvey ML, Luciano JM, Liebeskind DS, Chalela JA. Modified National Institutes of Health Stroke Scale Can Be Estimated From Medical Records. Stroke. 2003;34:568-70.