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Clot Busting Also Benefits Patients Unable to Live Independently Before Stroke

DALLAS – Intravenous clot busting appears to be safe and effective even for patients who are unable to live completely independently before suffering a stroke.

That’s according to new research published in the American Heart Association's journal Stroke.

The European multicenter study researched the effect of intravenous thrombolysis (IVT) among ischemic stroke patients with preexisting dependency, defined as being unable to live alone without help from another person. Background information in the report notes that patients with prior dependency are often excluded from clinical trials of IVT and, therefore, might not be treated with clot busters due to the expected higher risk of bleeding complications and lower treatment response.

"These findings prove that randomized-controlled IVT trials should be considered for such patients," said lead author Henrik Gensicke, MD, of the University Hospital Basel in Switzerland.

Among 7,430 IVT-treated patients in 12 European stroke centers, 6.6% were dependent prior to stroke. Researchers determined the degree of disability at three months after stroke onset and whether the group reached at least pre-stroke dependence levels.

Prior stroke, dementia, heart, and bone diseases were the most common causes of preexisting dependency, and the dependent patients tended to be older, more often female, had suffered more severe strokes, and were more likely to be prescribed antithrombotic medication than previously independent patients.

While dependent patients were twice as likely to die as independent patients within three months after IVT treatment, poor outcome and intracranial hemorrhages were equally frequent in both groups.

Furthermore, among three-month survivors, the proportion of dependent patients with poor outcome did not differ from independent patients. In fact, after adjusting for age and stroke severity, dependent patients were at lower risk of poor outcomes than independent patients.

"Concerns of higher complication rates from IVT-treatment resulting in a less-than-favorable risk-benefit ratio for dependent patients might be unjustified and perhaps should be set aside to allow further study," Gensicke said in an American Heart Association press release.

“IVT-treated stroke patients who were dependent on the daily help of others before stroke carry a higher mortality risk than previously independent patients,” the study authors concluded. “The risk of symptomatic intracranial hemorrhage and the likelihood of poor outcome were not independently influenced by previous dependency. Among survivors, poor outcome was avoided at least as effectively in previously dependent patients. Thus, withholding IVT in previously dependent patients might not be justified.”

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