Risk factors for unexplained early neurological deterioration after intravenous thrombolysis: a meta-analysis

Area of Science:

• Neurology
• Stroke Medicine
• Clinical Research

Background:

• Early neurological deterioration (END) is a critical complication following intravenous thrombolysis (IVT) in acute ischemic stroke (AIS).
• Identifying risk factors for END is crucial for improving patient outcomes and developing targeted interventions.

Purpose of the Study:

• To systematically identify and analyze risk factors associated with unexplained END after IVT in AIS patients.
• To explore potential mechanisms underlying the contribution of these factors to END onset and progression.

Main Methods:

• A systematic literature search was conducted across PubMed, Web of Science, and EMBASE databases following PRISMA guidelines.
• A meta-analysis included 16 studies investigating END in AIS patients treated with IVT within 4.5 hours of symptom onset.
• Data synthesis focused on identifying significant associations between various factors and post-IVT END incidence.

Main Results:

• The overall incidence of END in AIS patients receiving IVT was 12% (95% CI, 10%-15%).
• Significant risk factors identified include advanced age, male sex, hypertension, diabetes mellitus, atrial fibrillation, use of antihypertensives and antiplatelets, hyperglycemia, elevated white blood cell count, cholesterol levels, blood pressure, treatment timing, and large artery atherosclerosis (LAA).

Conclusions:

• Monitoring a range of factors, including comorbidities and specific biomarkers, is essential for managing and potentially preventing END.
• The role of white blood cells in END following AIS warrants further investigation to guide the development of targeted preventive therapies.