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Polypharmacy, functional outcome and treatment effect of intravenous alteplase for acute ischaemic stroke

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DOI

  • M. Jensen, University of Hamburg
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  • F. Boutitie, Hospices Civils de Lyon, Universite Claude Bernard Lyon 1
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  • B. Cheng, University of Hamburg
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  • T. H. Cho, Institut National des Sciences Appliquees de Lyon, Hospices Civils de Lyon
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  • M. Ebinger, Charité – Universitätsmedizin Berlin, Neurologie der Rehaklinik Medical Park Humboldtmühle
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  • M. Endres, Charité – Universitätsmedizin Berlin, German Center for Neurodegenerative Diseases, German Centre for Cardiovascular Research
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  • J. B. Fiebach, Charité – Universitätsmedizin Berlin
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  • J. Fiehler, University of Hamburg
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  • I. Ford, University of Glasgow
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  • I. Galinovic, Charité – Universitätsmedizin Berlin
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  • A. Königsberg, University of Hamburg
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  • J. Puig, University of Girona
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  • P. Roy, Hospices Civils de Lyon, Universite Claude Bernard Lyon 1
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  • A. Wouters, KU Leuven, Flanders Institute for Biotechnology
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  • V. Thijs, University of Melbourne
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  • R. Lemmens, KU Leuven, Flanders Institute for Biotechnology
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  • K. W. Muir, University of Glasgow
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  • N. Nighoghossian, Institut National des Sciences Appliquees de Lyon, Hospices Civils de Lyon
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  • S. Pedraza, University of Girona
  • ,
  • C. Z. Simonsen
  • C. Gerloff, University of Hamburg
  • ,
  • G. Thomalla, University of Hamburg

Background and purpose: Polypharmacy is an important challenge in clinical practice. Our aim was to determine the effect of polypharmacy on functional outcome and treatment effect of alteplase in acute ischaemic stroke. Methods: This was a post hoc analysis of the randomized, placebo-controlled WAKE-UP trial of magnetic resonance imaging guided intravenous alteplase in unknown onset stroke. Polypharmacy was defined as an intake of five or more medications at baseline. Comorbidities were assessed by the Charlson Comorbidity Index (CCI). The primary efficacy variable was favourable outcome defined by a score of 0–1 on the modified Rankin Scale at 90 days. Logistic regression analysis was used to test for an association of polypharmacy with functional outcome, and for interaction of polypharmacy and the effect of thrombolysis. Results: Polypharmacy was present in 133/503 (26%) patients. Patients with polypharmacy were older (mean age 70 vs. 64 years; p < 0.0001) and had a higher score on the National Institutes of Health Stroke Scale at baseline (median 7 vs. 5; p = 0.0007). A comorbidity load defined by a CCI score ≥ 2 was more frequent in patients with polypharmacy (48% vs. 8%; p < 0.001). Polypharmacy was associated with lower odds of favourable outcome (adjusted odds ratio 0.50, 95% confidence interval 0.30–0.85; p = 0.0099), whilst the CCI score was not. Treatment with alteplase was associated with higher odds of favourable outcome in both groups, with no heterogeneity of treatment effect (test for interaction of treatment and polypharmacy, p = 0.29). Conclusion: In stroke patients, polypharmacy is associated with worse functional outcome after intravenous thrombolysis independent of comorbidities. However, polypharmacy does not interact with the beneficial effect of alteplase.

Original languageEnglish
JournalEuropean Journal of Neurology
Volume28
Issue2
Pages (from-to)532-539
Number of pages8
ISSN1351-5101
DOIs
Publication statusPublished - Feb 2021

    Research areas

  • alteplase, intravenous thrombolysis, ischaemic stroke, polypharmacy, WAKE-UP

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