Effect of erroneous body-weight estimation on outcome of thrombolyzed stroke patients
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Effect of erroneous body‑weight estimation on outcome of thrombolyzed stroke patients Prakash R. Paliwal1,4 · Arvind K. Sharma2 · R. N. Komal Kumar3 · Lily Y. H. Wong1,4 · Bernard P. L. Chan1,4 · Hock Luen Teoh1,4 · Vijay K. Sharma1,4,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Intravenously administered tissue plasminogen activator (IV-tPA), dose determined by patients’ body-weight, remains the only approved drug treatment for acute ischemic stroke (AIS). Since a shorter onset-to-treatment time results in better functional outcome, treatment is often initiated according to the estimated or last-known body-weight of the patient. This approach may result in underdosing or overdosing of tPA. In this multicenter retrospective study, we evaluated the extent of error in tPA dosing in our AIS cohort and its impact on functional outcome and symptomatic intracranial hemorrhage (SICH). Consecutive AIS patients, receiving IV-tPA, dose determined by the estimated body-weight, at three tertiary centers between January and December 2017 were included. Collected data included information about demographics, cardiovascular risk factors, stroke subtype and National Institute of Health Stroke Scale (NIHSS) score. Estimated and measured body-weights were recorded. Modified Rankin scale (mRS) of 2 or more defined unfavorable outcome. The study included 150 patients. Median age was 64 -years (IQR 55–75) with male preponderance (67%) and median NIHSS score of 9 points (IQR 6–17). Mean measured weight of our study population was 58 (SD 13) kg. Median difference between actual and estimated bodyweight was 3 kg (IQR 1.5–6). Difference was more than 10% in 35 (23.3%) patients. Good functional outcome (mRS 0–1) was achieved by 74 (49.3%) patients and 10 (6.8%) developed SICH. NIHSS (OR 1.288; 95% CI 1.157–1.435, p 5 kg difference (%) Number of cases with > 10 kg difference (%) Number of cases with > 20 kg difference (%)
3.0 (1.5–6.0) 55 (36.7) 23 (15.3) 8 (5.3)
between actual and estimated weight noted in our study was 23 kg (50% of actual body-weight). The proportion of patients and well as magnitude of under- or overestimation was not statistically different among the three study centers. The mean time difference between weight estimation and measurement was 22 (SD 13) h. Overall, good functional outcome (mRS 0–1) was achieved in 74 (49.3%) patients. A total of 10 (6.8%) patients developed SICH and 10 (6.8%) patients died within 3 months. Differences in the variables associated
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Table 3 Differences in the characteristics of patients with good (mRS 0–1) and unfavorable (mRS 2–6) functional outcome at 3 months (n = 150)
P. R. Paliwal et al. Variable
Good outcome (n = 74)
Unfavorable outcome (n = 76)
p-value
Median age in years (IQR) Male gender Race, n (%) Chinese Non-Chinese Hypertension, n (%) Diabetes mellitus, n (%) Dyslipidemia, n (%) Ischemic heart disease, n (%) Atrial fibrillation, n (%) Smoking, n (%) Previous stroke, n (%) Median NIHSS on arrival (IQR) Stroke subtype, n (%) LA
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