Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction

Area of Science:

• Neurology
• Nephrology
• Emergency Medicine

Background:

• Acute ischemic stroke is a leading cause of disability.
• Renal dysfunction is common in stroke patients and may affect treatment decisions.
• Intravenous tissue plasminogen activator (tPA) is a key treatment for acute ischemic stroke.

Purpose of the Study:

• To evaluate the efficacy and safety of tPA in acute ischemic stroke patients with varying degrees of renal dysfunction.
• To assess the impact of low estimated glomerular filtration rate (eGFR) on tPA treatment outcomes.

Main Methods:

• Retrospective analysis of 3525 ischemic stroke patients from the Taiwan Stroke Registry (August 2006 - May 2015).
• Patients were grouped by eGFR (<60 ml/min/1.73 m² or on dialysis vs. ≥60 ml/min/1.73 m²).
• Propensity score matching was used to compare outcomes (modified Rankin Scale ≥2) and risks (intracerebral hemorrhage, GI bleeding, mortality) at 1, 3, and 6 months post-tPA treatment.

Main Results:

• In patients with eGFR <60 ml/min/1.73 m², tPA therapy significantly reduced the odds of poor functional outcome at 6 months (OR = 0.60; 95% CI = 0.42-0.87).
• tPA therapy was not associated with increased upper gastrointestinal bleeding risk.
• An increased risk of intracerebral hemorrhage was observed with tPA, but low eGFR was not a significant risk factor for this complication.

Conclusions:

• tPA treatment improves functional outcomes in acute ischemic stroke patients, regardless of renal function.
• Renal dysfunction, specifically low eGFR, does not significantly increase the risk of intracerebral hemorrhage in patients receiving tPA.
• tPA is a safe and effective treatment option for acute ischemic stroke patients with renal impairment, without increasing upper gastrointestinal bleeding risk.