Abstract TP403: Presence Of Severe Aphasia Reduces Benefit From Thrombolytic Therapy
Background: Patients with severe aphasia are underrepresented in randomized clinical trials because of difficulties getting an informed consent. We wanted to know, if the presence of a severe aphasia influences benefit or risk from thrombolytic therapy.
Methods: Retrospective analysis of a prospectively collected dataset of patients treated with thrombolytic therapy. For this analysis we included every patient with a supratentorial infarction treated with rtPA or thrombectomy between 1998 and 2011. Aphasia was graded at admission following item 9 of the NIHSS by an experienced speech-and-language-pathologist. All patients were treated following institutional SOP at an ICU or a certified stroke unit. Outcome was assessed using the modified Rankin scale (mRS) three months after treatment; good clinical outcome was defined as mRS 0-2. Symptomatic intracranial hemorrhage (sICH) was defined as in ECASS2. Univariate (Fisher’s exact or Mann-Whitney U tests) and multivariate (logistic regression) analyses were applied using outcome parameters as dependent and those variables having a p-value of <0.1 in univariate tests as independent variables. The NIHSS was corrected for this analysis by subtracting the aphasia-score.
Results: Overall 1.345 patients were analyzed: 645 had no, 76 mild, 190 moderate and 433 a severe aphasia. After adjustment for sex, side of infarction, type of treatment, hypertension, diabetes, CAD, atrial fibrillation, age, NIHSSc presence of severe aphasia was negative predictive for a good clinical outcome (OR 0.46; 95%CI 0.33-0.65; p<0.0001). In addition severe aphasia was associated with increased mortality after adjustment for sex, type of treatment, hypertension, diabetes, smoking, previous stroke, CAD, PAD, atrial fibrillation, age and NIHSS (OR 1.85; 95%CI 1.32-2.61; p=0.0004). There was no clear association with the risk of suffering from a sICH (p=0.096).
Conclusion: In this analysis we discovered that patients with severe aphasia had a lower chance of being clinically independent after thrombolytic therapy and had a higher mortality compared to patients with no or mild aphasia. This is probably due to the involvement of larger brain areas - especially cortical territories - in patients with severe aphasia.
- © 2012 by American Heart Association, Inc.