Back to Search
Start Over
Rescue therapy of early neurological deterioration in lacunar stroke.
- Source :
-
BMC neurology [BMC Neurol] 2024 Sep 07; Vol. 24 (1), pp. 329. Date of Electronic Publication: 2024 Sep 07. - Publication Year :
- 2024
-
Abstract
- Background: Early neurological deterioration (END) occurs in many patients with acute ischemic stroke due to a variety of causes. Although pharmacologically induced hypertension (PIH) and anticoagulants have been investigated in several clinical trials for the treatment of END, the efficacy and safety of these treatments remain unclear. Here, we investigated whether PIH or anticoagulation is better as a rescue therapy for the progression of END in patients with lacunar stroke.<br />Methods: This study included patients with lacunar stroke who received rescue therapy with END within 3 days of symptom onset between April 2014 and August 2021. In the PIH group, phenylephrine was administered intravenously for 24 h and slowly tapered when symptoms improved or after 5 days of PIH. In the anticoagulation group, argatroban was administered continuously intravenously for 2 days and twice daily for next 5 days. We compared END recovery, defined as improvement in NIHSS from baseline, excellent outcomes (0 or 1 mRS at 3 months), and safety profile.<br />Results: Among the 4818 patients with the lacunar stroke, END occurred in 147 patients. Seventy-nine patients with END received PIH (46.9%) and 68 patients (46.3%) received anticoagulation therapy. There was no significant difference in age (P = 0.82) and sex (P = 0.87) between the two groups. Compared to the anticoagulation group, the PIH group had a higher incidence of END recovery (77.2% vs. 51.5%, P < 0.01) and excellent outcomes (34.2% vs. 16.2%, P = 0.04). PIH was associated with END (HR 2.49; 95% CI 1.06-5.81, P = 0.04). PIH remained associated with END recovery (adjusted HR 3.91; 95% CI 1.19-12.90, P = 0.02). Safety outcomes, like hemorrhagic conversion and mortality, were not significantly different between the two groups.<br />Conclusions: As a rescue therapy for the progression of END in lacunar stroke patients, PIH with phenylephrine was more effective with similar safety compared to anticoagulation with argatroban.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Aged
Middle Aged
Hypertension drug therapy
Hypertension complications
Aged, 80 and over
Sulfonamides therapeutic use
Sulfonamides administration & dosage
Arginine analogs & derivatives
Arginine therapeutic use
Arginine administration & dosage
Treatment Outcome
Antihypertensive Agents therapeutic use
Antihypertensive Agents administration & dosage
Retrospective Studies
Disease Progression
Pipecolic Acids
Stroke, Lacunar drug therapy
Anticoagulants therapeutic use
Anticoagulants administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2377
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC neurology
- Publication Type :
- Academic Journal
- Accession number :
- 39244562
- Full Text :
- https://doi.org/10.1186/s12883-024-03825-7