Abstract
Whether the glycaemic control during the first hours of cerebral ischaemia treated by thrombolysis influences outcomes remains unsettled. We aimed at evaluating the quality of the glycaemic control and whether patients with well-controlled glycaemia after thrombolysis for acute cerebral ischaemia have better outcomes. We retrospectively analysed data prospectively collected in consecutive stroke patients who received i.v. thrombolysis at the Lille University Hospital. Patients with glycaemia >1.6 g/l (8.9 mmol/l) at any point during the first 48 h received insulin. We used 2 definitions of well controlled glycaemia: (i) “well controlled 100 %” when 100 % glycaemia were <1.6 g/l (8.9 mmol/l), and (ii) “well controlled 70 %” when at least 70 % glycaemia were <1.6 g/l (8.9 mmol/l). The outcome measures at 3 months were (1) independence [modified Rankin scale (mRS) score 0 or 1], (2) absence of handicap (mRS 0–2), (3) death, and (4) symptomatic intracerebral haemorrhage (sICH). Of 875 consecutive patients, 657 (75.2 %) were considered as well controlled with a threshold at 100 % and 736 (84.2 %) with a threshold at 70 %. The glycaemic control was not independently associated with any of the four outcome measures. In patients treated by insulin, hypoglycaemic events were rare (2.1 % of all patients) and of moderate intensity [>0.5 g/l (2.8 mmol/l)]. The quality of the glycaemic control was not associated with outcomes in patients treated by thrombolysis. A possible explanation is that the glycaemic control after thrombolysis has minor influence compared with glycaemic control before thrombolysis when the artery is not yet re-open and the penumbra area at maximum.
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Didier Leys and Charlotte Cordonnier have been investigators for the ECASS-3 trial (honorarium paid to Adrinord). Rachel Litke, Solène Moulin and Pierre Fontaine report no disclosure.
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The study has been approved by the appropriate ethic committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons or their relatives gave their informed consent prior to their inclusion in the study.
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Litke, R., Moulin, S., Cordonnier, C. et al. Influence of glycaemic control on the outcomes of patients treated by intravenous thrombolysis for cerebral ischaemia. J Neurol 262, 2504–2512 (2015). https://doi.org/10.1007/s00415-015-7874-5
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DOI: https://doi.org/10.1007/s00415-015-7874-5