Sulfonylurea Pretreatment and In-Hospital Use Does Not Impact Acute Ischemic Strokes (AIS) Outcomes Following Intravenous Thrombolysis

Georgios Tsivgoulis; Nitin Goyal; Sulaiman Iftikhar; Ramin Zand; Jason J Chang; Lucas Elijovich; Anne W Alexandrov; Marc D Malkoff; Andrei V Alexandrov

doi:10.1016/j.jstrokecerebrovasdis.2016.10.019

Sulfonylurea Pretreatment and In-Hospital Use Does Not Impact Acute Ischemic Strokes (AIS) Outcomes Following Intravenous Thrombolysis

J Stroke Cerebrovasc Dis. 2017 Apr;26(4):795-800. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.019. Epub 2016 Nov 16.

Authors

Georgios Tsivgoulis¹, Nitin Goyal², Sulaiman Iftikhar³, Ramin Zand³, Jason J Chang³, Lucas Elijovich⁴, Anne W Alexandrov⁵, Marc D Malkoff³, Andrei V Alexandrov³

Affiliations

¹ Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
² Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: ngoyal@uthsc.edu.
³ Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
⁴ Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
⁵ Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Australian Catholic University, Sydney, New South Wales, Australia.

PMID: 27865697
DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.019

Abstract

Background and purpose: Preliminary studies have indicated that sulfonylurea drugs (SUD) may confer protection against cerebral swelling and hemorrhagic transformation in severe acute ischemic stroke (AIS). We sought to determine whether pretreatment and in-hospital use of SUD may be associated with better outcomes in diabetic AIS patients treated with intravenous thrombolysis (IVT).

Subjects and methods: We analyzed consecutive diabetic AIS patients treated with IVT during a 3-year period. Pretreatment with SUD, admission NIHSS (National Institutes of Health Stroke Scale) score, NIHSS at 48 hours, and modified Rankin Scale (mRS) at discharge were documented. Patients who discontinued SUD during hospitalization were excluded. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH with NIHSS score increase of greater than or equal to 4 points within 72 hours. Early neurological improvement was defined as an NIHSS score decrease of greater than or equal to 4 points or NIHSS score of 0 at 48 hours. Cerebral edema was documented by neuroradiology reports. Favorable functional outcome (FFO) was defined as discharge mRS of 0-1.

Results: A total of 148 diabetic AIS patients were evaluated (mean age 64 ± 11 years, 49% men, median admission NIHSS score: 8 points). We identified 42 (28%) cases pretreated with SUD. The prevalence of complications and favorable outcomes did not differ (P > .1) between patients pretreated and nonpretreated with SUD: sICH (2% versus 5%), cerebral edema (5% versus 4%), early neurological improvement (42% versus 43%), in-hospital mortality (12% versus 5%), and FFO (22% versus 32%).

Conclusions: Pretreatment and in-hospital use of SUD appears not to be associated with early favorable outcomes and lower likelihood of potential complications in diabetic AIS patients treated with IVT.

Keywords: Intravenous thrombolysis; cerebral edema; favorable outcome; safety; strokes; sulfonylurea.

MeSH terms

Administration, Intravenous
Aged
Brain Ischemia / complications
Diabetic Angiopathies / complications
Drug Administration Schedule
Female
Hospital Mortality
Hospitals / statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Stroke / etiology
Stroke / therapy*
Sulfonylurea Compounds / administration & dosage*
Thrombolytic Therapy / adverse effects*
Time Factors
Treatment Outcome

Substances

Sulfonylurea Compounds