Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis

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dc.contributor.authorCarr, Susan
dc.contributor.authorWang, Xia
dc.contributor.authorOlavarria, Veronica
dc.contributor.authorLavados, Pablo
dc.contributor.authorRodriguez, Jorge
dc.contributor.authorKim, Jong
dc.contributor.authorLee, Tsong-Hai
dc.contributor.authorLindley, Richard
dc.contributor.authorPontes-Neto, Octavio
dc.contributor.authorRicci, Stefano
dc.contributor.authorSato, Shoichiro
dc.contributor.authorSharma, Vijay
dc.contributor.authorWoodward, Mark
dc.contributor.authorChalmers, John
dc.contributor.authorAnderson, Craig
dc.contributor.authorRobinson, Thompson
dc.contributor.authoron behalf of the ENCHANTED Investigators
dc.date.accessioned2018-01-24T15:20:10Z
dc.date.available2018-01-24T15:20:10Z
dc.date.issued2017
dc.description.abstractBACKGROUND AND PURPOSE: Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS: A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. RESULTS: Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. CONCLUSIONS: RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.
dc.format.extent5
dc.identifier.citationCarr SJ, Wang X, Olavarria VV, Lavados PM, Rodriguez JA, Kim JS, Lee TH, Lindley RI, Pontes-Neto OM, Ricci S, Sato S, Sharma VK, Woodward M, Chalmers J, Anderson CS, Robinson TG; ENCHANTED Investigators. Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis. Stroke. 2017 Sep;48(9):2605-2609.
dc.identifier.urihttp://hdl.handle.net/11447/1970
dc.identifier.urihttp://dx.doi.org/10.1161/STROKEAHA.117.017808
dc.language.isoen_US
dc.publisherAmerican Heart Association
dc.subjectglomerular filtration rate
dc.subjecthypertension
dc.subjectintracranial hemorrhages
dc.subjectodds ratio
dc.subjectstroke
dc.titleInfluence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis
dc.typeArtículo

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