Highlights
- •We use a national inpatient database in Japan.
- •Propensity-score matching analyses are performed.
- •Edaravone improves early outcomes in acute ischemic stroke patients treated with rtPA.
- •Randomized control trials are needed to further evaluate the efficacy of edaravone.
Abstract
Background
We investigated whether edaravone could improve early outcomes in acute ischemic stroke
patients treated with recombinant tissue plasminogen activator (rtPA).
Methods
We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination
database. We identified patients admitted with a primary diagnosis of ischemic stroke
from 1 July 2010 to 31 March 2012 and treated with rtPA on the same day of stroke
onset or the following day. Thereafter, we selected those who received edaravone on
the same day of rtPA administration (edaravone group), and those who received rtPA
without edaravone (control group). The primary outcomes were modified Rankin Scale
(mRS) scores at discharge. One-to-one propensity-score matching was performed between
the edaravone and control groups. An ordinal logistic regression analysis for mRS
scores at discharge was performed with adjustment for possible variables as well as
clustering of patients within hospitals using a generalized estimating equation.
Results
We identified 6336 eligible patients for inclusion in the edaravone group (n = 5979; 94%) and the control group (n = 357; 6%) as the total population. In 356 pairs of the propensity-matched population,
the ordinal logistic regression analysis showed that edaravone was significantly associated
with lower mRS scores of patients at discharge (adjusted odds ratio: 0.74; 95% confidence
interval: 0.57–0.96).
Conclusions
Edaravone may improve early outcomes in acute ischemic stroke patients treated with
rtPA.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tissue plasminogen activator for acute ischemic stroke.N Engl J Med. 1995; 333: 1581-1587https://doi.org/10.1056/NEJM199512143332401
- Tissue plasminogen activator (tPA) increase neuronal damage after focal cerebral ischemia in wild-type and tPA-deficient mice.Nat Med. 1998; 4: 228-231https://doi.org/10.1038/nm0298-228
- Comparative effects of tissue plasminogen activator, streptokinase, and staphylokinase on cerebral ischemic infarction and pulmonary clot lysis in hamster models.Circulation. 1999; 100: 2541-2546https://doi.org/10.1161/01.CIR.100.25.2541
- Comparison of the European and Japanese guidelines for the management of ischemic stroke.Cerebrovasc Dis. 2013; 35: 402-418https://doi.org/10.1159/000351753
- Edaravone, a free radical scavenger, inhibits MMP-9-related brain hemorrhage in rats treated with tissue plasminogen activator.Stroke. 2009; 40: 626-631https://doi.org/10.1161/STROKEAHA.108.520262
- Dissociation and protection of the neurovascular unit after thrombolysis and reperfusion in ischemic rat brain.J Cereb Blood Flow Metab. 2009; 29: 715-725https://doi.org/10.1038/jcbfm.2008.164
- Free radical scavenger edaravone administration protects against tissue plasminogen activator induced oxidative stress and blood brain barrier damage.Curr Neurovasc Res. 2010; 7: 319-329https://doi.org/10.2174/156720210793180747
- Administration of edaravone, a free radical scavenger, during t-PA infusion can enhance early recanalization in acute stroke patients—a preliminary study.J Neurol Sci. 2012; 313: 132-136https://doi.org/10.1016/j.jns.2011.09.006
- Intravenous thrombolysis with neuroprotective therapy by edaravone for ischemic stroke patients older than 80 years of age.J Stroke Cerebrovasc Dis. 2013; 22: 1175-1183https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.010
- Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT).Stroke. 2006; 37: 1810-1815https://doi.org/10.1161/01.STR.0000227191.01792.e3
- Effect of a novel free radical scavenger, edaravone (MCI-186), on acute brain infarction.Cerebrovasc Dis. 2003; 15: 222-229https://doi.org/10.1159/000069318
- Clinical analysis of 207 patients who developed renal disorders during or after treatment with edaravone reported during post-marketing surveillance.Clin Exp Nephrol. 2007; 11: 292-296https://doi.org/10.1007/s10157-007-0495-2
- NXY-059 for acute ischemic stroke.N Engl J Med. 2006; 354: 588-600https://doi.org/10.1056/NEJMoa052980
- New grading of level of disordered consiousness (author's transl).No Shinkei Geka. 1974; 2: 623-627
- The eye response test alone is sufficient to predict stroke outcome—reintroduction of Japan Coma Scale: a cohort study.BMJ Open. 2013; 3: e002736https://doi.org/10.1136/bmjopen-2013-002736
- Indications for computed tomography in patients with mild head injury.Neurol Med Chir (Tokyo). 2007; 47: 291-298https://doi.org/10.2176/nmc.47.291
- Guidelines for the intravenous application of recombinant tissue-type plasminogen activator (alteplase), the second edition, October 2012: a guideline from the Japan Stroke Society.J Stroke Cerebrovasc Dis. 2013; https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.001
- Optimizing discharge planning: clinical predictors of longer stay after recombinant tissue plasminogen activator for acute stroke.Stroke. 2005; 36: 147-150https://doi.org/10.1161/01.STR.0000150492.12838.66
- Constructing a control group using multivariate matched sampling methods that incorporate the propensity score.Am Stat. 1985; 39: 33https://doi.org/10.2307/2683903
- Day-90 acute ischemic stroke outcomes can be derived from early functional activity level.Cerebrovasc Dis. 2010; 29: 50-56https://doi.org/10.1159/000255974
- Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group.N Engl J Med. 1999; 340: 1781-1787https://doi.org/10.1056/NEJM199906103402302
- Factors predicting outcome in stroke patients treated with 0.6 mg/kg alteplase: evidence from the Japan Alteplase Clinical Trial (J-ACT).J Stroke Cerebrovasc Dis. 2011; 20: 517-522
- Stroke care units versus general medical wards for acute management of stroke in Japan.Stroke. 2013; 44: 3142-3147https://doi.org/10.1161/STROKEAHA.113.001684
- Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial.Stroke. 2008; 39: 366-372https://doi.org/10.1161/STROKEAHA.107.492330
- Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR).Stroke. 2009; 40: 2442-2449https://doi.org/10.1161/STROKEAHA.109.548602
- Effects of hyperacute blood pressure and heart rate on stroke outcomes after intravenous tissue plasminogen activator.J Hypertens. 2011; 29: 1980-1987https://doi.org/10.1097/HJH.0b013e32834a764e
- The THRombolysis and STatins (THRaST) study.Neurology. 2013; 80: 655-661https://doi.org/10.1212/WNL.0b013e318281cc83
- Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study.BMJ Qual Saf. 2014; 23: 215-222https://doi.org/10.1136/bmjqs-2013-002218
Article info
Publication history
Published online: July 16, 2014
Accepted:
July 8,
2014
Received in revised form:
June 21,
2014
Received:
April 10,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
