Diabetes and thrombolysis for acute stroke: a clear benefit for diabetics

Authors

  • M. Reiter,

    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
    2. Department of Neurology, Danube Clinic Tulln, Tulln, Austria
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  • Y. Teuschl,

    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
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  • K. Matz,

    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
    2. Department of Neurology, Danube Clinic Tulln, Tulln, Austria
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  • L. Seyfang,

    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
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  • M. Brainin,

    Corresponding author
    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
    2. Department of Neurology, Danube Clinic Tulln, Tulln, Austria
    • Correspondence: M. Brainin, Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, A-3500 Krems, Austria (tel.: +43 2732 893 2814; fax: +43 2732 893 4810; e-mail: Michael.Brainin@donau-uni.ac.at).

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  • and for the Austrian Stroke Unit Registry Collaborators

    Corresponding author
    1. Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria
    • Correspondence: M. Brainin, Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, A-3500 Krems, Austria (tel.: +43 2732 893 2814; fax: +43 2732 893 4810; e-mail: Michael.Brainin@donau-uni.ac.at).

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  • This is a Continuing Medical Education article, and can be found with corresponding questions on the Internet at http://www.efns.org/EFNS Continuing-Medical-Education-online.301.0.html. Certificates for correctly answering the questions will be issued by the EFNS.

Abstract

Background and purpose

Diabetes is a predictor for poor outcome after thrombolysis in stroke patients, and early post-stroke glycaemia is associated with higher rates of post-thrombolytic symptomatic intracerebral haemorrhages (SICHs). Diabetic stroke patients may nevertheless profit from thrombolysis. Here, we compared outcome data of matched thrombolysed and non-thrombolysed diabetic and non-diabetic stroke patients from a national database.

Methods

The outcomes of 1079 matched quadruples, each consisting of a thrombolysed diabetic, a non-thrombolysed diabetic, a thrombolysed non-diabetic and a non-thrombolysed non-diabetic case (a total of 4316 cases), enrolled in the Austrian Stroke Unit Registry (2004–2013), were compared. Patients were matched according to sex, age, stroke severity, pre-stroke disability and prior stroke.

Results

A regression model with improvement as depending variable found no effect of diabetes (P = 0.158) or the interaction diabetes × thrombolysis (P = 0.507), whereas the effect of thrombolysis itself was highly significant (P < 0.001). Functional outcome (modified Rankin Scale) was significantly better in thrombolysed than in non-thrombolysed diabetic patients at discharge from the stroke-unit (P < 0.001) and 3 months later (P = 0.006). No significant differences were found in the number of SICHs after thrombolytic treatment between diabetic (4.9%) and non-diabetic strokes (3.5%). Both groups had a higher risk of SICH compared with the non-thrombolysed groups (diabetics 2.6%, non-diabetics 2.5%). Due to lack of documentation, the effect of admission blood glucose on SICH was not investigated.

Conclusions

Data from this nationwide survey show that diabetic stroke patients receive a substantial benefit from thrombolysis, and therefore diabetic strokes should not be excluded from thrombolytic treatment.

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