Acute ischemic stroke patients with diabetes should not be excluded from intravenous thrombolysis

• Published in: Journal of thrombosis and thrombolysis Vol. 38; no. 4; pp. 522 - 527
• Main Authors: Fuentes, Blanca, Cruz-Herranz, Andrés, Martínez-Sánchez, Patricia, Rodríguez-Sanz, Ana, Ruiz Ares, Gerardo, Prefasi, Daniel, Sanz-Cuesta, Borja E., Lara-Lara, Manuel, Díez-Tejedor, Exuperio
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-11-2014; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Brain Ischemia - epidemiology; Cardiology; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; Female; Fibrinolytic Agents - administration & dosage; Hematology; Humans; Infusions, Intravenous; Male; Medicine; Medicine & Public Health; Middle Aged; Registries; Stroke - diagnosis; Stroke - drug therapy; Stroke - epidemiology; Treatment Outcome; Stroke; Ischemic stroke; Diabetes; Intravenous thrombolysis; Outcome
• ISSN: 0929-5305; 1573-742X
• DOI: 10.1007/s11239-014-1110-5

The benefit of intravenous thrombolysis (IVT) has been questioned for patients with diabetes mellitus (DM) in cases of acute ischemic stroke (IS). Our objective was to analyze the differences in outcome according to prior diagnosis of DM and the use or not of IVT. Observational study with inclusion of consecutive IS patients admitted to an stroke unit. Demographic data, vascular risk factors, comorbidity, stroke severity and 3-month follow-up outcome (modified Rankin Scale) were compared according to prior diagnosis of DM and the use or not of IVT. A total of 1,139 IS patients were admitted; 283 (24.8 %) patients had a diagnosis of DM, and 261 were IVT treated (23.2 % of the group without DM and 21.9 % of the DM group). The IVT-treated patients with DM were older, had more comorbidities and had higher glucose levels on admission than those without DM and than IVT-treated patients. No significant differences in stroke severity, hemorrhagic transformation, in-hospital mortality or outcome at 3 months were found. The logistic regression analysis showed that stroke severity was associated with a higher risk of a poor outcome in IVT-treated patients, with no significant effect from DM after adjustment for confounders. Moreover, IVT was independently associated with a lower risk of poor outcome in DM patients (OR 0.49; 95 % CI 0.31–0.76;
P
 = .002). DM patients should not be excluded from IVT, because DM is not associated with a poor outcome after IVT and this treatment is clearly beneficial for DM patients as compared with DM patients not treated with IVT.