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Withholding of Thrombolytic Treatment Not Justified

Thrombolytic therapy in patients with diabetes or history of stroke leads to improved outcomes

WEDNESDAY, Dec. 22 (HealthDay News) -- Outcomes for patients with diabetes or history of stroke who receive thrombolytic therapy for a new ischemic stroke are better than outcomes for those who do not receive thrombolytic therapy, according to a report in the December issue of Diabetes Care.

Nishant Kumar Mishra, M.B.B.S., of the University of Glasgow in the United Kingdom, and colleagues collected data on 5,817 patients. Of these, 1,585 were thrombolysed and 4,232 were nonthrombolysed. A total of 1,334 had diabetes, whereas 1,898 had a history of prior stroke and 491 had both. Outcomes were compared based on age, pretreatment baseline National Institutes of Health Stroke Scale (b-NIHSS), and 90-day outcome measures.

The researchers found significantly improved outcomes when thrombolytic therapy was used in patients with either diabetes or prior stroke history. Compared to nonthrombolysed patients with diabetes, thrombolysed patients had a 30 percent increased odds of a better functional outcome. Compared to nonthrombolysed patients with previous stroke, thrombolysed patients with previous stroke also had higher odds of a better functional outcome (odds ratio, 1.3). However, the improvement among patients who had both diabetes and history of stroke did not reach statistical significance.

"Our analysis shows improved outcomes among patients with diabetes, those who have had a prior stroke, and those with diabetes and/or prior stroke, though marginally failed to show a statistically significant improvement in the patients who had both diabetes and a prior stroke together. We however believe that a potential benefit might exist for the combined group too, and withholding a proven therapy [thrombolysis] among these patients would not be justified," the authors write.

Several authors disclosed receiving honoraria from pharmaceutical companies.

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