1. Association of prestroke metformin use, stroke severity, and thrombolysis outcome
- Author
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Sixtine Gilliot, Hebun Erdur, Christian H. Nolte, Paul J. Nederkoorn, Mauro Magoni, Christian Hametner, Andrea Zini, Patrik Michel, Pierre Seners, Michael J Scherrer, Laura P. Westphal, Ashraf Eskandari, Jonathan M. Coutinho, Sami Curtze, Yannick Béjot, Nicolas Martinez-Majander, Céline Brenière, Georg Kägi, Adrien E. Groot, Didier Leys, Alexandros A Polymeris, Laura Vandelli, Ulrike Held, Alessandro Pezzini, Stefan T. Engelter, Andreas R. Luft, Jan F. Scheitz, Marcel Arnold, Marjaana Tiainen, Roni Widmer, Klaus Steigmiller, Susanne Wegener, Peter A. Ringleb, Christopher Traenka, Mirjam Rachel Heldner, Visnja Padjen, Dejana R. Jovanović, Turgut Tatlisumak, Guillaume Turc, Henrik Gensicke, University of Zurich, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Graduate School, and ACS - Amsterdam Cardiovascular Sciences
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,610 Medicine & health ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Modified Rankin Scale ,Internal medicine ,Diabetes mellitus ,Epidemiology ,medicine ,Humans ,Hypoglycemic Agents ,Thrombolytic Therapy ,cardiovascular diseases ,10064 Neuroscience Center Zurich ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Recovery of Function ,10060 Epidemiology, Biostatistics and Prevention Institute (EBPI) ,Thrombolysis ,Middle Aged ,medicine.disease ,Metformin ,10040 Clinic for Neurology ,3. Good health ,2728 Neurology (clinical) ,Diabetes Mellitus, Type 2 ,Propensity score matching ,Cohort ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
ObjectiveTo evaluate whether pretreatment with metformin (MET) is associated with less stroke severity and better outcome after IV thrombolysis (IVT), we analyzed a cohort of 1,919 patients with stroke with type 2 diabetes mellitus in a multicenter exploratory analysis.MethodsData from patients with diabetes and ischemic stroke treated with IVT were collected within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration. We applied propensity score matching (PSM) to obtain balanced baseline characteristics of patients treated with and without MET.ResultsOf 1,919 patients with stroke with type 2 diabetes who underwent IVT, 757 (39%) had received MET before stroke (MET+), whereas 1,162 (61%) had not (MET−). MET+ patients were younger with a male preponderance. Hypercholesterolemia and pretreatment with statins, antiplatelets, or antihypertensives were more common in the MET+ group. After PSM, the 2 groups were well balanced with respect to demographic and clinical aspects. Stroke severity on admission (NIH Stroke Scale 10.0 ± 6.7 vs 11.3 ± 6.5), 3-month degree of independence on modified Rankin Scale (2 [interquartile range (IQR) 1.0–4.0] vs 3 [IQR 1.0–4.0]), as well as mortality (12.5% vs 18%) were significantly lower in the MET+ group. The frequency of symptomatic intracerebral hemorrhages did not differ between groups. HbA1c levels were well-balanced between the groups.ConclusionsPatients with stroke and diabetes on treatment with MET receiving IVT had less severe strokes on admission and a better functional outcome at 3 months. This suggests a protective effect of MET resulting in less severe strokes as well as beneficial thrombolysis outcome.
- Published
- 2020