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Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings
Author(s) -
Poupore Nicolas,
Strat Dan,
Mackey Tristan,
Brown Katherine,
Snell Ashley,
Nathaniel Thomas I.
Publication year - 2020
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12426
Subject(s) - medicine , stroke (engine) , ischemic stroke , confounding , inclusion and exclusion criteria , logistic regression , emergency medicine , ischemia , alternative medicine , pathology , mechanical engineering , engineering
Background This study investigates the risk factors associated with exclusion or inclusion for thrombolytic therapy in TIA‐ischemic stroke patients in a telestroke compared with a non‐telestroke setting. Methods This study retrospectively analyzes regional stroke data collected between January 2010 and June 2016 from TIA‐ischemic stroke patients. We used the logistic regression model to predict clinical risk factors associated with exclusion or inclusion for thrombolytic therapy in the telestroke and non‐telestroke setting. Results This study identified a total of 299 ischemic stroke patients with a history of TIAs. Of these, 98 patients received treatment in a telestroke setting, while 201 received treatment in a non‐telestroke setting. The telestroke excluded fewer patients (58%) and administered thrombolytic therapy to 42% of TIA‐ischemic stroke patients. The non‐telestroke setting excluded 89% of patients, while only 11% of TIA‐ischemic stroke patients received rtPA. In the telestroke setting, a history of previous TIA > 24 hours (OR = 16.014, 95% CI, 4.112‐62.368, P < .001) was associated with rtPA inclusion, while higher blood glucose levels (OR = 0.984, 95% CI, 0.969‐0.999, P = .042) were associated with an rtPA exclusion. Conclusion After adjusting for the effect of confounding variables, we found direct admission to be significant for exclusion in the non‐telestroke setting. Moreover, there was a significant association between hyperglycemia and exclusion from thrombolytic therapy in TIA‐ischemic stroke patients in the telestroke setting.