Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25060
Title: Polypharmacy, functional outcome, and treatment effect of intravenous alteplase for acute ischemic stroke.
Austin Authors: Jensen, Märit;Boutitie, Florent;Cheng, Bastian;Cho, Tae-Hee;Ebinger, Martin;Endres, Matthias;Fiebach, Jochen B;Fiehler, Jens;Ford, Ian;Galinovic, Ivana;Königsberg, Alina;Puig, Josep;Roy, Pascal;Wouters, Anke;Thijs, Vincent N ;Lemmens, Robin;Muir, Keith W;Nighoghossian, Norbert;Pedraza, Salvador;Simonsen, Claus Z;Gerloff, Christian;Thomalla, Götz
Affiliation: Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
Neurologie der Rehaklinik Medical Park Humboldtmühle, An der Mühle 2-9, 13507, Berlin, Germany
Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France
Neurology
The Florey Institute of Neuroscience and Mental Health
VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Herestraat 49, bus 602, 3000, Leuven, Belgium
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Oude Markt 13, 5005, 3000, Belgium
Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
German Center for Cardiovascular Research (DZHK), partner site Berlin
German Center for Neurodegenerative Disease (DZNE), partner site Berlin
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
Robertson Centre for Biostatistics, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France
Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, 17190, Salt, Girona, Spain
Department of Neurology, Aarhus University Hospital, 8000, Aarhus, Denmark
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
Issue Date: 5-Oct-2020
metadata.dc.date: 2020-10-05
Publication information: European Journal of Neurology 2020; online first: 5 October
Abstract: Polypharmacy is an important challenge in clinical practice. We aimed at determining the effect of polypharmacy on functional outcome and treatment effect of alteplase in acute ischemic stroke. Post-hoc analysis of the randomized, placebo-controlled WAKE-UP trial of MRI-guided intravenous alteplase in unknown onset stroke. Polypharmacy was defined as intake of ≥5 medications at baseline. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The primary efficacy variable was favorable outcome defined by a score of 0-1 on the modified Rankin Scale at 90 days. We used logistic regression analysis to test for an association of polypharmacy with functional outcome, and for interaction of polypharmacy and the effect of thrombolysis. Polypharmacy was present in 133/503 (26%) patients. Patients with polypharmacy were older (mean age 70 vs 64 years; P<0.0001) and had a higher score on the National Institutes of Health Stroke Scale at baseline (median 7 vs 5; P=0.0007). A comorbidity load defined by a CCI score ≥2 was more frequent in patients with polypharmacy (48% vs 8%; P<0.001). Polypharmacy was associated with lower odds of favorable outcome (adjusted odds ratio 0.50, 95% CI, 0.30-0.85; P=0.0099), while the CCI score was not. Treatment with alteplase was associated with higher odds of favorable outcome in both groups, with no heterogeneity of treatment effect (test for interaction of treatment and polypharmacy, P=0.29). In stroke patients, polypharmacy is associated with worse functional outcome after intravenous thrombolysis independent of comorbidities. However, polypharmacy does not interact with the beneficial effect of alteplase.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25060
DOI: 10.1111/ene.14566
ORCID: 0000-0001-7793-0941
0000-0003-0594-4409
PubMed URL: 33015924
Type: Journal Article
Subjects: Polypharmacy
WAKE-UP
alteplase
intravenous thrombolysis
ischemic stroke
Appears in Collections:Journal articles

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