PhD ceremony Ms. I. Miedema: Prognostic factors of functional outcome in acute ischemic stroke

PhD ceremony: Ms. I. Miedema, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Prognostic factors of functional outcome in acute ischemic stroke

Promotor(s): prof. H.P.H. Kremer, prof. J. De Keyser

Faculty: Medical Sciences

In the last decades, the development of revascularisation therapy with intravenous recombinant tissue plasminogen antigen (tPA) has greatly improved the outcome of acute ischemic stroke patients, but this therapy is only available for a selected group of patients and has safety concerns. In this thesis several possible neuroprotective agents in acute ischemic stroke and some safety aspects of tPA-treatment are discussed. In a cohort of patients with acute ischemic stroke treated with intravenous tPA no improvement of functional outcome at 3 months after the event was found in patients using selective serotonin re-uptake inhibitor (SSRI) or statin. Serum uric acid levels were also unrelated to improvement outcomes in patients with acute ischemic stroke. Concerning safety, for all stroke subtypes, hyperglycemia during admission was associated with a poor functional outcome in patients treated with tPA. Using vitamin-K-antagonist in patients with normal or slightly elevated International Normalized Ratio (INR) who are treated with tPA, is associated with the risk of symptomatic intracranial hemorrhage (SICH), but not with the actual functional outcome at 3 months after ischemic stroke. In conclusion, the studies in this thesis do not support a neuroprotective effect of SSRIs, statins and serum uric acid levels in patients with acute ischemic stroke. Treatment with tPA is still the most effective therapy for acute ischemic stroke and selection of patients to reduce treatment risks is important. Use of vitamin-K-antagonist with elevated INR and admission hyperglycemia are associated with the occurrence of SICH and poor functional outcome respectively.