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Predictors of major neurologic improvement after thrombolysis in acute stroke

From the Stroke Program, Department of Clinical Neurological Sciences, London Health Science Center, The University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Dr. Gustavo Saposnik, 339 Windermere Rd., Stroke Service, Office 7-GE5, London Health Science Centre, London, ON N6A 5A5, Canada; e-mail: gsaposni{at}uwo.ca

Background: Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months.

Objective: To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months.

Methods: The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003. Major neurologic improvement was defined by a 8-point improvement in NIH Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 hours. Good outcome was defined as a 3-month modified Rankin Scale of 0 to 1.

Results: Of 219 patients with acute stroke treated with rt-PA, 61 (28%) had major neurologic improvement at 24 hours. Glucose levels <8 mmol/L (OR 4.98, 95% CI 1.6 to 15.2), lack of cortical involvement on 24 hour CT scan (OR 3.97, 95% CI 1.87 to 8.43), and female sex (OR 2.4, 95% CI 1.12 to 5.13) were associated with major neurologic improvement after adjusting for covariates. Patients with major neurologic improvement had a shorter hospital stay (6.7 vs 14.3 days; p = 0.001). Major neurologic improvement was an independent predictor of good outcome at 3 months (OR 12.8, 95% CI 4.72 to 34.6).

Conclusions: Major neurologic improvement after rt-PA was observed in 28% of patients and independently predicted good outcome at 3 months. Female sex, glucose levels < 8 mmol/L, and absence of cortical involvement at 24 hours CT scan were associated with major neurologic improvement.

Supported in part by a grant from the Canadian Institute for Health Research (CIHR) and the Heart Stroke Foundation of Canada (HSFC) given to Dr. Gustavo Saposnik obtained based on competitive applications following publication of grant advertisements.

Disclosure: The authors report no conflicts of interest.

Received March 8, 2005. Accepted in final form July 11, 2005.

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