A model to prevent fibrinolysis in patients with stroke mimics

Jason Chang, Mohamed Teleb, Julian P. Yang, Yazan J. Alderazi, Kristina Chapple, James L. Frey, Lucas Restrepo

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates. Methods: This retrospective study was carried out at a single institution. Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA; n = 193) were divided into 3 categories: acute ischemic stroke (n = 142), aborted stroke (n = 21), and stroke mimics (n = 30). Analysis of variance and the chi-square test were used to assess differences, while logistic regression models were computed to predict groups. Results: Mimics treated with rt-PA did not experience complications (intracranial bleeding, systemic hemorrhage, or angioedema), and had better neurologic and functional outcomes than stroke patients (P <.05). Several variables helped differentiate strokes from mimics, including atherosclerosis on computed tomographic angiography (odds ratio [OR] 23.6; 95% confidence interval [CI] 8.4-66.2), atrial fibrillation (OR 11.4; 95% CI 1.5-86.3), age >50 years (OR 7.2; 95% CI 2.8-18.5), and focal weakness (OR 4.15; 95% CI 1.75-9.8). Other variables decreased chances of stroke: migraine history (OR 0.05; 95% CI 0.01-0.4), epilepsy (OR 0.13; 95% CI 0.02-0.8), paresthesia (OR 0.1; 95% CI 0.04-0.3), and precordialgia (OR 0.045; 95% CI 0.002-0.9). A regression model using focal weakness, computed tomographic angiography findings, and precordialgia had a 90.2% predictive accuracy. Conclusions: IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.

Original languageEnglish (US)
Pages (from-to)839-843
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume21
Issue number8
DOIs
StatePublished - Nov 2012

Fingerprint

Fibrinolysis
Stroke
Angiography
Logistic Models
Hemorrhage
Angioedema
Paresthesia
Tissue Plasminogen Activator
Chi-Square Distribution
Migraine Disorders
Nervous System
Epilepsy
Analysis of Variance
Retrospective Studies

Keywords

  • Acute ischemic stroke
  • computed tomographic angiography
  • emergency medicine
  • fibrinolysis
  • outcomes
  • recombinant tissue plasminogen activator
  • stroke mimics

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Chang, J., Teleb, M., Yang, J. P., Alderazi, Y. J., Chapple, K., Frey, J. L., & Restrepo, L. (2012). A model to prevent fibrinolysis in patients with stroke mimics. Journal of Stroke and Cerebrovascular Diseases, 21(8), 839-843. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.018

A model to prevent fibrinolysis in patients with stroke mimics. / Chang, Jason; Teleb, Mohamed; Yang, Julian P.; Alderazi, Yazan J.; Chapple, Kristina; Frey, James L.; Restrepo, Lucas.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 21, No. 8, 11.2012, p. 839-843.

Research output: Contribution to journalArticle

Chang, J, Teleb, M, Yang, JP, Alderazi, YJ, Chapple, K, Frey, JL & Restrepo, L 2012, 'A model to prevent fibrinolysis in patients with stroke mimics', Journal of Stroke and Cerebrovascular Diseases, vol. 21, no. 8, pp. 839-843. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.018
Chang, Jason ; Teleb, Mohamed ; Yang, Julian P. ; Alderazi, Yazan J. ; Chapple, Kristina ; Frey, James L. ; Restrepo, Lucas. / A model to prevent fibrinolysis in patients with stroke mimics. In: Journal of Stroke and Cerebrovascular Diseases. 2012 ; Vol. 21, No. 8. pp. 839-843.
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abstract = "Background: Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates. Methods: This retrospective study was carried out at a single institution. Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA; n = 193) were divided into 3 categories: acute ischemic stroke (n = 142), aborted stroke (n = 21), and stroke mimics (n = 30). Analysis of variance and the chi-square test were used to assess differences, while logistic regression models were computed to predict groups. Results: Mimics treated with rt-PA did not experience complications (intracranial bleeding, systemic hemorrhage, or angioedema), and had better neurologic and functional outcomes than stroke patients (P <.05). Several variables helped differentiate strokes from mimics, including atherosclerosis on computed tomographic angiography (odds ratio [OR] 23.6; 95{\%} confidence interval [CI] 8.4-66.2), atrial fibrillation (OR 11.4; 95{\%} CI 1.5-86.3), age >50 years (OR 7.2; 95{\%} CI 2.8-18.5), and focal weakness (OR 4.15; 95{\%} CI 1.75-9.8). Other variables decreased chances of stroke: migraine history (OR 0.05; 95{\%} CI 0.01-0.4), epilepsy (OR 0.13; 95{\%} CI 0.02-0.8), paresthesia (OR 0.1; 95{\%} CI 0.04-0.3), and precordialgia (OR 0.045; 95{\%} CI 0.002-0.9). A regression model using focal weakness, computed tomographic angiography findings, and precordialgia had a 90.2{\%} predictive accuracy. Conclusions: IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.",
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AU - Teleb, Mohamed

AU - Yang, Julian P.

AU - Alderazi, Yazan J.

AU - Chapple, Kristina

AU - Frey, James L.

AU - Restrepo, Lucas

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N2 - Background: Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates. Methods: This retrospective study was carried out at a single institution. Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA; n = 193) were divided into 3 categories: acute ischemic stroke (n = 142), aborted stroke (n = 21), and stroke mimics (n = 30). Analysis of variance and the chi-square test were used to assess differences, while logistic regression models were computed to predict groups. Results: Mimics treated with rt-PA did not experience complications (intracranial bleeding, systemic hemorrhage, or angioedema), and had better neurologic and functional outcomes than stroke patients (P <.05). Several variables helped differentiate strokes from mimics, including atherosclerosis on computed tomographic angiography (odds ratio [OR] 23.6; 95% confidence interval [CI] 8.4-66.2), atrial fibrillation (OR 11.4; 95% CI 1.5-86.3), age >50 years (OR 7.2; 95% CI 2.8-18.5), and focal weakness (OR 4.15; 95% CI 1.75-9.8). Other variables decreased chances of stroke: migraine history (OR 0.05; 95% CI 0.01-0.4), epilepsy (OR 0.13; 95% CI 0.02-0.8), paresthesia (OR 0.1; 95% CI 0.04-0.3), and precordialgia (OR 0.045; 95% CI 0.002-0.9). A regression model using focal weakness, computed tomographic angiography findings, and precordialgia had a 90.2% predictive accuracy. Conclusions: IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.

AB - Background: Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates. Methods: This retrospective study was carried out at a single institution. Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA; n = 193) were divided into 3 categories: acute ischemic stroke (n = 142), aborted stroke (n = 21), and stroke mimics (n = 30). Analysis of variance and the chi-square test were used to assess differences, while logistic regression models were computed to predict groups. Results: Mimics treated with rt-PA did not experience complications (intracranial bleeding, systemic hemorrhage, or angioedema), and had better neurologic and functional outcomes than stroke patients (P <.05). Several variables helped differentiate strokes from mimics, including atherosclerosis on computed tomographic angiography (odds ratio [OR] 23.6; 95% confidence interval [CI] 8.4-66.2), atrial fibrillation (OR 11.4; 95% CI 1.5-86.3), age >50 years (OR 7.2; 95% CI 2.8-18.5), and focal weakness (OR 4.15; 95% CI 1.75-9.8). Other variables decreased chances of stroke: migraine history (OR 0.05; 95% CI 0.01-0.4), epilepsy (OR 0.13; 95% CI 0.02-0.8), paresthesia (OR 0.1; 95% CI 0.04-0.3), and precordialgia (OR 0.045; 95% CI 0.002-0.9). A regression model using focal weakness, computed tomographic angiography findings, and precordialgia had a 90.2% predictive accuracy. Conclusions: IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.

KW - Acute ischemic stroke

KW - computed tomographic angiography

KW - emergency medicine

KW - fibrinolysis

KW - outcomes

KW - recombinant tissue plasminogen activator

KW - stroke mimics

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