dc.contributor.author
Schlemm, Ludwig
dc.contributor.author
Kufner, Anna
dc.contributor.author
Boutitie, Florent
dc.contributor.author
Nave, Alexander Heinrich
dc.contributor.author
Gerloff, Christian
dc.contributor.author
Thomalla, Götz
dc.contributor.author
Simonsen, Claus Z.
dc.contributor.author
Ford, Ian
dc.contributor.author
Lemmens, Robin
dc.contributor.author
Muir, Keith W.
dc.contributor.author
Nighoghossian, Norbert
dc.contributor.author
Pedraza, Salvador
dc.contributor.author
Ebinger, Martin
dc.contributor.author
Endres, Matthias
dc.date.accessioned
2020-01-10T12:48:21Z
dc.date.available
2020-01-10T12:48:21Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/26373
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-26134
dc.description.abstract
Background: The "smoking paradox" indicates that patients with acute ischemic stroke (AIS) who smoke at the time of their stroke may have a better prognosis after intravenous thrombolysis than non-smokers. However, findings are inconsistent and data analyzing the effect of smoking on treatment efficacy of intravenous thrombolysis are scarce. Methods: We performed a pre-specified post-hoc subgroup analysis of the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial that randomized AIS patients with unknown time of symptom onset who had diffusion-weighted imaging-fluid attenuation inversion recovery (DWI-FLAIR) mismatch to either alteplase or placebo. Patients were categorized as current smokers or non-smokers (including former smokers and never-smokers). Baseline demographic and clinical characteristics, as well as clinical and imaging follow-up data were analyzed according to smoking status. Results: Four hundred and eighty six patients were included in the analysis. Current smokers (133, 27.4%) were younger (60.1 ± 13.0 vs. 67.2 ± 10.3 years; p < 0.001) and less often had arterial hypertension (45.0% vs. 56.8%; p = 0.02) or atrial fibrillation (3.8% vs. 15.3%; p < 0.001). The acute stroke presentation was more often due to large vessel occlusion among current smokers (27.1 vs. 16.2%; p = 0.01), and smokers had a trend towards more severe strokes (National Institutes of Health Stroke Scale score>10 in 27.1% vs. 19.5%; p = 0.08). The treatment effect of alteplase, quantified as odds ratio for a favorable outcome (modified Rankin Scale [mRS] score at 90 days of 0 or 1), did not differ between current smokers and non-smokers (p-value for interaction: 0.59). After adjustment for age and stroke severity, neither the proportion of patients with favorable outcome, nor the median mRS score at 90 days differed between current smokers and non-smokers. When additional potential confounders were included in the model, the median mRS score was higher in current smokers than in non-smokers (cOR of better outcome for current smokers vs. non-smokers: 0.664 [0.451-0.978], p = 0.04). Conclusions: In patients with mild to moderate MRI-proven AIS and unknown time of symptom onset with DWI-FLAIR mismatch, current smokers had worse functional outcome as compared to non-smokers. Current smoking did not modify the treatment effect of alteplase. Clinical Trial registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered 02 February 2012.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
acute therapy
en
dc.subject
cerebrovascular diseases
en
dc.subject
ischemic stroke
en
dc.subject
thrombolysis (tPA)
en
dc.subject
treatment outcome and efficacy
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Current Smoking Does Not Modify the Treatment Effect of Intravenous Thrombolysis in Acute Ischemic Stroke Patients-A Post-hoc Analysis of the WAKE-UP Trial
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
1239
dcterms.bibliographicCitation.doi
10.3389/fneur.2019.01239
dcterms.bibliographicCitation.journaltitle
Frontiers in Neurology
dcterms.bibliographicCitation.originalpublishername
Frontiers Media S.A.
dcterms.bibliographicCitation.volume
10
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
31824412
dcterms.isPartOf.eissn
1664-2295