Studies by AHN Neurologists Improve Understanding of Stroke Therapy Risks in Patients With Chronic Health Conditions

Intravenous thrombolysis may put stroke patients with chronic kidney disease at a higher risk for intracranial bleeding and mortality, according to a recent study published in the journal Neurology by researchers at the Allegheny Health Network (AHN) Neuroscience Institute. The study, “Intravenous Thrombolysis in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis,” surveyed various studies published across different countries and assessed the association of chronic kidney disease among more than 60,000 acute ischemic stroke patients undergoing IV thrombolytic therapy.

According to the Centers for Disease Control and Prevention, stroke kills about 140,000 Americans each year, accounting for approximately one out of every 20 deaths. Nearly 90% of strokes are classified as acute ischemic strokes which take place when a blood clot or narrowed artery obstructs blood flow to the brain. Within minutes, the lack of oxygenated blood to the brain can cause a severe, permanent neurological injury, and even death.

“Patients who suffer an acute ischemic stroke and arrive early to the hospital are often administered IV thrombolysis to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs,” says Konark Malhotra, MD, vascular neurologist at Allegheny General Hospital and the AHN Neuroscience Institute, and principal investigator of the study. “We wanted to better understand how this course of treatment with IV thrombolytic therapy may impact an already vulnerable population with a specific chronic condition like chronic kidney disease.”

In the systematic review, Malhotra and his colleagues evaluated outcomes with special attention being paid to intracranial bleeding, three-month mortality, and functional independence rates with regard to a patient’s mobility and ability to maintain high levels of self-sufficiency.

Across 20 independent studies that were analyzed, a significant correlation was determined to exist between chronic kidney disease and worsened clinical outcomes—most notably, a higher risk of intracranial bleeding and mortality.

“The primary causation of worsened outcomes presents an opportunity for further research. A likely contributing factor is the high rate of comorbidities seen in the study population; for example, hypertension and diabetes are the leading causes of chronic kidney disorder,” says Ashis Tayal, MD, neurologist and director of the Allegheny General Hospital Stroke Center.

In addition to Malhotra and Tayal, other neurologists who contributed to the study include Aristeidis H. Katsanos, Nitin Goyal, Henrik Gensicke, Panayiotis D. Mitsias, Gian Marco De Marchis, Eivind Berge, Anne W. Alexandrov, Andrei V. Alexandrov, and Georgios Tsivgoulis.

In another study published earlier this year in the AHA journal Hypertension, Malhotra’s team provided additional insight on how clinical outcomes of acute ischemic stroke patients who undergo stroke thrombectomy procedures are impacted by elevated blood pressure levels.

Malhotra performed a systematic review and pooled results from 25 published studies involving 6,500 patients who underwent acute stroke thrombectomy. This study analyzed the association of blood pressure—systolic and diastolic—before, during, or after acute stroke thrombectomy with various clinical outcomes. The authors found that higher blood pressure levels negatively affect stroke related outcomes such as intracranial bleeding, death, and functional independence in daily living.

“Studies such as those led by Dr. Malhotra and his team are essential to improving our understanding of chronic disease management and developing better therapeutic strategies that can make a life-changing difference for stroke patients,” Tayal says.

Source: Allegheny Health Network