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당뇨병과 뇌졸중 병력을 모두 가진 급성 뇌경색 환자에서 증상 발생 3-4.5시간대 정맥내혈전용해술의 안전성 및 효과

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Author(s)
Boyoung KimJi Sung LeeHong-Kyun ParkYoung Bok YungKi Chang OhJeong Joo ParkYong-Jin ChoKyusik KangSoo Joo LeeJae Guk KimJae-Kwan ChaDae-Hyun KimHee-Joon BaeTai Hwan ParkSang-Soon ParkKyung Bok LeeJun LeeByung-Chul LeeMinwoo LeeJoon-Tae KimKang-Ho ChoiDong-Eog KimJay Chol ChoiDong-Ick ShinJee-Hyun KwonWook-Joo KimSung Il SohnJeong-Ho HongHyung Jong ParkSeong-Hwa JangKwang-Yeol ParkSang-Hwa LeeJong-Moo ParkKeun-Sik Hong
Keimyung Author(s)
Sohn, Sung IlHong, Jeong HoPark, Hyung Jong
Department
Dept. of Neurology (신경과학)
Journal Title
대한신경과학회지
Issued Date
2023
Volume
41
Issue
2
Keyword
Diabetes mellitusStrokeThrombolytic therapyTissue plasminogen activator3- to 4.5-hour time window
Abstract
Background:
For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients.

Methods:
Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927).

Results:
The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]).

Conclusions:
In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.
Alternative Title
Safety and Efficacy of Intravenous Thrombolysis in the 3- to 4.5-hour Window in Acute Ischemic Stroke Patients Who Have Both Diabetes Mellitus and History of Prior Stroke
Keimyung Author(s)(Kor)
손성일
홍정호
박형종
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2288-985X
Source
https://www.jkna.org/journal/view.php?doi=10.17340/jkna.2023.2.2
DOI
10.17340/jkna.2023.2.2
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44906
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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