ArticleTranslational stroke research2014
Hyperglycemia worsens outcome after rt-PA primarily in the large-vessel occlusive stroke subtype.
Article in Translational stroke research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Persistent hyperglycemia is a useful glycemic pattern to predict stroke mortality: a systematic review and meta-analysis.BMC neurology · 2021Pooled it
- Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review.Journal of diabetes investigation · 2019Pooled it
- Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis.Neurocritical care · 2018Pooled it
- Thrombolysis for acute ischaemic stroke.The Cochrane database of systematic reviews · 2014Pooled it
- Effect of Admission Hyperglycemia on Safety and Efficacy of Intravenous Alteplase Before Thrombectomy in Ischemic Stroke: Post-hoc Analysis of the DIRECT-MT trial.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2022Trial
- Argatroban Increased the Basal Vein Drainage and Improved Outcomes in Acute Paraventricular Ischemic Stroke Patients.Medical science monitor : international medical journal of experimental and clinical research · 2020Trial
- Blood Glucose Levels and Stroke Severity in Patients with Acute Small Subcortical Infarct.Brain sciences · 2025Article
- Canagliflozin, an Inhibitor of the NaCells · 2023Article
- The Effect of Locally Administered Fibrinolytic Drugs Following Aneurysmal Subarachnoid Hemorrhage : A Meta-Analysis with Eight Randomized Controlled Studies.Journal of Korean Neurosurgical Society · 2021Article
- Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China.Frontiers in neurology · 2021Article
- Elevated blood glucose is associated with aggravated brain edema in acute stroke.Journal of neurology · 2020Article
- Telemedicine in Prehospital Acute Stroke Care: An Expanding Infrastructure for Treatment and Research.Journal of the American Heart Association · 2019Article
- Complement Component C3 Promotes Cerebral Ischemia/Reperfusion Injury Mediated by TLR2/NFκB Activation in Diabetic Mice.Neurochemical research · 2018Article
- Efficacy of Novel Carbon Nanoparticle Antioxidant Therapy in a Severe Model of Reversible Middle Cerebral Artery Stroke in Acutely Hyperglycemic Rats.Frontiers in neurology · 2018Article
- Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma.Frontiers in neurology · 2018Article
- Hematoma Expansion Following Intracerebral Hemorrhage: Mechanisms Targeting the Coagulation Cascade and Platelet Activation.Current drug targets · 2017Review
- A Post-stroke Therapeutic Regimen with Omega-3 Polyunsaturated Fatty Acids that Promotes White Matter Integrity and Beneficial Microglial Responses after Cerebral Ischemia.Translational stroke research · 2016Article
- Embracing Biological and Methodological Variance in a New Approach to Pre-Clinical Stroke Testing.Translational stroke research · 2016Article
- Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes?BMC neurology · 2016Article
- An Outcome Model for Intravenous rt-PA in Acute Ischemic Stroke.Translational stroke research · 2015Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
Hyperglycemia at the time of ischemic stroke has been associated with poorer outcomes. Preclinical literature suggests that hyperglycemia is an independent prognostic factor and the vasculature is more vulnerable to reperfusion injury. We applied a method to match subjects on important baseline factors to test whether, independent of stroke severity, stroke subtype influences the effect of hyperglycemia on outcome after recombinant tissue plasminogen activator (rt-PA). We reanalyzed the NINDS rt-PA dataset with respect to matching variables baseline NIHSS, age, and investigator-determined stroke subtypes small-vessel occlusive stroke (SVS), large-vessel occlusive stroke (LVS), and cardioembolic stroke (CES), above and below a glucose threshold of 150 mg/dl. Ninety-day outcomes were compared. Post hoc baseline matching was excellent in most cases. Hyperglycemia was associated with worsened functional outcome mostly in the LVS subtype with increased mortality in the placebo arm (15.3% mortality normoglycemia vs. 30.6% hyperglycemia; p = .046), worse functional outcome in the rt-PA arm (modified Rankin Score (mRS) 0-1; 46.3 vs. 22.0%; p = .034), and no improvement in functional outcome with rt-PA compared to placebo (mRS 0-1; 25% in both groups). Among hyperglycemic subjects, CES subjects showed significant improvement following rt-PA (p = .027). After matching for baseline severity, the influence of hyperglycemia on outcome was primarily in the LVS subtype, especially after rt-PA. This finding is consistent with a deleterious effect of hyperglycemia on ischemia/reperfusion of symptomatic large arteries. If confirmed, the particular vulnerability of the LVS subtype is important in understanding the role of stroke subtype in the mechanism of worsening and potential treatment of hyperglycemic stroke patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.