Document Detail

Smoking-thrombolysis paradox: recanalization and reperfusion rates after intravenous tissue plasminogen activator in smokers with ischemic stroke.
MedLine Citation:
PMID:  23287785     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The so-called smoking-thrombolysis paradox of an improved outcome after thrombolysis was first described in smokers with myocardial infarction. We investigated whether reperfusion rates and clinical outcome differ between smokers and nonsmokers with ischemic stroke after intravenous tissue plasminogen activator.
METHODS: Consecutive acute ischemic stroke patients, who had magnetic resonance imaging before and 1 day after thrombolysis, were included for analysis. All of the patients received intravenous tissue plasminogen activator within 4.5 hours. Reperfusion was defined as a 75% reduction in perfusion deficit (mean transit time >6 s) after thrombolysis compared with baseline. Magnetic resonance angiography was used to evaluate arterial stenosis and occlusion. Functional outcome was assessed 3 months after stroke using the modified Rankin Score.
RESULTS: Of 148 patients, 21.6% were smokers (n=32). Smokers were younger (median, 61 years [SD, 9.4 years] versus 75 years [SD, 11.6 years]; P<0.001), less often women (28% versus 51%; P=0.03), had lower baseline glucose levels (median, 6.2 mmol/L [interquartile range, 5.7-6.8 mmol/L] versus 6.7 mmol/L [interquartile range, 6.1-8.2 mmol/L]; P<0.01) and higher baseline perfusion deficits (median, 53 mL [interquartile range, 13-141 mL] versus 17 mL [interquartile range, 2-66 mL]; P=0.04). In a backward stepwise regression analysis including age, sex, hypertension, glucose, perfusion deficit, and smoking, smoking had an odds ratio of 4 (95% confidence interval, 1-16; P=0.03) for reperfusion and 6 (95% confidence interval, 1-30; P=0.05) for recanalization (regression analysis for recanalization also included localization of arterial occlusion). Smokers had a better outcome (modified Rankin Score=0-2) than nonsmokers (77% versus 55%; P=0.05).
CONCLUSIONS: Smoking is independently associated with recanalization and reperfusion, indicating that thrombolytic therapy acts more effectively in smokers; because of small numbers, these results should be considered preliminary. Clinical Trial Registration- URL: Unique Identifier: NCT00715533.
Anna Kufner; Christian H Nolte; Ivana Galinovic; Peter Brunecker; Gerald M Kufner; Matthias Endres; Jochen B Fiebach; Martin Ebinger
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-01-03
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  44     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-03-11     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  407-13     Citation Subset:  IM    
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
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MeSH Terms
Aged, 80 and over
Brain Ischemia / drug therapy,  epidemiology*
Endovascular Procedures* / methods
Injections, Intravenous
Middle Aged
Reperfusion / trends*
Retrospective Studies
Smoking / adverse effects*,  drug therapy,  epidemiology*
Stroke / drug therapy,  epidemiology*
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Reg. No./Substance:
EC Plasminogen Activator
Comment In:
Stroke. 2013 May;44(5):e58   [PMID:  23559266 ]
Stroke. 2013 May;44(5):e59

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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