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Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Meagan Reynolds, Brice Blum, Leanne Brechtel, Jordan Gainey and Thomas I Nathaniel*

Background- The disparities in stroke care between specialized stroke units and non-stroke units have been reported. While most of the existing studies investigated how intrinsic characteristics of specific treatment units have impact on the outcomes, the influence of patients’ characteristics on functional outcomes of recombinant tissue plasminogen activator-treated patients in specialized stroke units and non-stroke units is not fully understood.

Method- The demographic and clinical risk factors that significantly impact functional improvement outcomes in recombinant tissue plasminogen activator-treated acute ischemic stroke in the non-stroke unit and the specialized stroke unit were determined. Univariate analysis was used to determine improved functional differences, while adjusted multivariable models were used to determine the association between demographic and clinical variables on the functional outcome.

Results- In stroke patients that received recombinant tissue plasminogen activator in the specialized stroke unit and the non-stroke unit, a history of previous transient ischemic attack (ORadj, 0.347, 95% CI (0.160, 0.752); p=0.007) and patients taking antiplatelet medications (ORadj, 1.954, 95% CI (1.116, 3.421, p=0.019) were significantly associated with improved functional outcome. Patients with a history of carotid artery stenosis (ORadj, 5.265, 95% CI (1.067, 2.977), p=0.041) and a history of transient ischemic attack (ORadj, 0.295, 95% CI (0.100, 0.872), p=0.027) were significantly associated with improved functional outcome following treatment with recombinant tissue plasminogen activator in the specialized stroke unit. In the adjusted model analysis for the non-stroke unit, the major predictors of functional outcome were: the NIH stroke scale (ORadj=1.381, 95% CI (1.086, 1.757), p=0.009), the risk of mortality (ORadj =0.691, 95% CI (0.518, 0.922) p=0.012), female gender (ORadj=0.306, 95% CI (0.120, 0.778), p=0.013), and race/ethnicity (ORadj=0.285, 95% CI (0.084, 0.970), p=0.045).

Conclusion- After the adjusted analysis, the specialized stroke unit and non-stroke unit reveal significantly improved functional outcomes for patients treated with recombinant tissue plasminogen activator in few clinical variables. Values for functional outcomes were not significantly associated with most of the variables for treated patients in both the specialized stroke unit and non-stroke unit even after adjustment in the recombinant tissue plasminogen activator–treated stroke population.