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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Acute ischemic stroke patients with diabetes should not be excluded from intravenous thrombolysis

Blanca Fuentes1, Andrés Cruz-Herranz, Patricia Martínez-Sánchez

  • 1Department of Neurology and Stroke Center, IdiPAZ Health Research Institute, La Paz University Hospital, Autonomous University of Madrid, Paseo de la Castellana 261, 28046, Madrid, Spain, blanca.fuentes@salud.madrid.org.

Journal of Thrombosis and Thrombolysis
|July 9, 2014
PubMed

Insights

Intravenous thrombolysis (IVT) is beneficial for acute ischemic stroke (IS) patients with diabetes mellitus (DM). Despite concerns, IVT does not worsen outcomes and is associated with a lower risk of poor outcomes in DM patients.

Area of Science:

  • Neurology
  • Cardiology
  • Endocrinology

Background:

  • The efficacy of intravenous thrombolysis (IVT) in acute ischemic stroke (IS) patients with diabetes mellitus (DM) remains debated.
  • Prior studies suggest potential disparities in treatment outcomes for diabetic stroke patients.

Purpose of the Study:

  • To investigate the impact of diabetes mellitus on outcomes following IVT for acute ischemic stroke.
  • To compare the effectiveness of IVT in patients with and without a history of DM.

Main Methods:

  • An observational study including 1,139 consecutive IS patients admitted to a stroke unit.
  • Data collected included demographics, vascular risk factors, comorbidities, stroke severity, and 3-month outcomes (modified Rankin Scale).
  • Patients were analyzed based on the presence of DM and receipt of IVT.

Main Results:

  • Of 1,139 patients, 283 (24.8%) had DM. IVT-treated DM patients were older, had more comorbidities, and higher admission glucose levels.
  • No significant differences were observed in stroke severity, hemorrhagic transformation, in-hospital mortality, or 3-month outcomes between DM and non-DM groups.
  • Logistic regression indicated stroke severity was linked to poor outcomes, but DM was not an independent predictor after adjustment. IVT was independently associated with better outcomes in DM patients (OR 0.49).

Conclusions:

  • Diabetes mellitus should not be a contraindication for IVT in acute ischemic stroke.
  • IVT is not associated with poorer outcomes in diabetic patients and offers significant benefits compared to no IVT.
  • These findings support the use of IVT in acute ischemic stroke patients with diabetes mellitus.

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