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May 11, 2019

ESOC-2019

“OUTCOME AFTER STROKE THROMBOLYSIS IN PATIENTS WITH DIABETES MELLITUS AND PRIOR CEREBRAL INFARCTION TREATED WITHIN 3-4.5 HOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS”

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acute stroke

diabetes mellitus

previous stroke

outcome

iv-rtpa

Abstract

Abstract

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Keywords

acute stroke

diabetes mellitus

previous stroke

outcome

iv-rtpa

Abstract

Background Patients with diabetes mellitus (DM) and with previous cerebral infarction (PCI) were considered relative contraindications for thrombolysis using intravenous recombinant tissue plasminogen activator (IV-rtPA) due to perceived safety concerns. Moreover, tolerability and efficacy endpoints of this intervention for these specific individuals has not been extensively reviewed previously in the literature. Objectives This study aimed to determine the safety and efficacy of IV-rtPA among diabetic patients with PCI presenting with acute ischemic stroke using a systematic review of relevant trials. Methods Major healthcare databases (PubMed, Science Citation Index Expanded, Cochrane Database of Systematic Review, CENTRAL and clinicaltrials.gov) were searched from inception to September 2018. Relevant studies evaluating the safety and efficacy outcomes of IV-rtPA among diabetic patients with history of PCI (>3 months) presenting with acute ischemic stroke were included. Results Four studies with a total of 18097 patients were included in this review. Incidence of symptomatic intracerebral hemorhage (RR 0.71, CI 0.27, 1.87), mortality (RR 2.16, CI 1.89, 2.46), and functional dependence (RR 1.14, CI 1.02, 1.27) is comparable among patients with or without DM and PCI after IV-rtPA. Good functional outcome is higher among patients with DM and PCI (RR 0.67, CI 0.61, 0.74). Cochrane-Mantel-Haenszel test showed no significant association between history of cerebral infarction and DM in the outcomes measured (X2=12.575, dF2, p=0.504) Conclusion DM and previous cerebral infarction do not result to higher incidence of symptomatic intracerebral hemorrhage, death, and functional dependence among patients who were given IV-rtPA thus providing evidence supporting the current guidelines on thrombolysis.

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© Copyright 2019 Morressier GmbH.
All rights reserved.