Elevated pretreatment blood pressure and IV thrombolysis in stroke

Neurology
Maaike DirksNyika D Kruyt

Abstract

We investigated whether an active blood pressure-lowering strategy is associated with more patients receiving thrombolytics compared with a conservative "watch and measure" strategy, and assessed safety and functional outcome of these 2 treatment strategies. This is a post hoc analysis in 2 randomized controlled stroke trials, the PRACTISE (Promoting Acute Thrombolysis in Ischemic Stroke) and the PASS (Preventive Antibiotics in Stroke Study). We included all patients with elevated pretreatment blood pressure above 185/110 mm Hg at presentation but otherwise eligible for IV thrombolysis (IVT). The decision to use an active or conservative strategy was in accordance with local hospital treatment guidelines. The primary outcome was the proportion of patients treated with IVT. Secondary outcomes were (1) symptomatic intracranial hemorrhage (increased neurologic deficit with a concomitant hemorrhage on neuroimaging), (2) functional outcome at 3 months, and (3) the door-to-needle time. We included 224 patients, 66 (29%) received the active and 158 (71%) the conservative strategy. In the active group, 55 patients (83%) received thrombolytics vs 87 (55%) in the conservative group, an increase of 28% (95% confidence interval: 16%-40%). ...Continue Reading

Citations

Aug 27, 2015·Expert Review of Cardiovascular Therapy·Michelle P LinDavid S Liebeskind
Jul 20, 2016·Bulletin of the World Health Organization·Aaron L Berkowitz
Oct 21, 2015·Multiple Sclerosis International·Justin M HonceEric Nyberg
Oct 20, 2015·Evolutionary Anthropology·Roy Larick, Russell L Ciochon
Aug 20, 2018·Current Treatment Options in Neurology·Mollie McDermott, Cemal B Sozener

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