TY - JOUR
T1 - Association of prestroke metformin use, stroke severity, and thrombolysis outcome
AU - Thrombolysis in Ischemic Stroke Patients (TRISP) Study Group
AU - Westphal, Laura P.
AU - Widmer, Roni
AU - Held, Ulrike
AU - Steigmiller, Klaus
AU - Hametner, Christian
AU - Ringleb, Peter
AU - Curtze, Sami
AU - Martinez-Majander, Nicolas
AU - Tiainen, Marjaana
AU - Nolte, Christian H.
AU - Scheitz, Jan F.
AU - Erdur, Hebun
AU - Polymeris, Alexandros A.
AU - Traenka, Christopher
AU - Eskandari, Ashraf
AU - Michel, Patrik
AU - Heldner, Mirjam R.
AU - Arnold, Marcel
AU - Zini, Andrea
AU - Vandelli, Laura
AU - Coutinho, Jonathan M.
AU - Groot, Adrien E.
AU - Padjen, Visnja
AU - Jovanovic, Dejana R.
AU - Bejot, Yannick
AU - Brenière, C. line
AU - Turc, Guillaume
AU - Seners, Pierre
AU - Pezzini, Alessandro
AU - Magoni, Mauro
AU - Leys, Didier
AU - Gilliot, Sixtine
AU - Scherrer, Michael J.
AU - Kägi, Georg
AU - Luft, Andreas R.
AU - Gensicke, Henrik
AU - Nederkoorn, Paul
AU - Tatlisumak, Turgut
AU - Engelter, Stefan T.
AU - Wegener, Susanne
PY - 2020/7/28
Y1 - 2020/7/28
N2 - OBJECTIVE: To evaluate whether pretreatment with metformin (MET) is associated with less stroke severity and better outcome after IV thrombolysis (IVT), we analyzed a cohort of 1,919 patients with stroke with type 2 diabetes mellitus in a multicenter exploratory analysis. METHODS: Data from patients with diabetes and ischemic stroke treated with IVT were collected within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration. We applied propensity score matching (PSM) to obtain balanced baseline characteristics of patients treated with and without MET. RESULTS: Of 1,919 patients with stroke with type 2 diabetes who underwent IVT, 757 (39%) had received MET before stroke (MET+), whereas 1,162 (61%) had not (MET-). MET+ patients were younger with a male preponderance. Hypercholesterolemia and pretreatment with statins, antiplatelets, or antihypertensives were more common in the MET+ group. After PSM, the 2 groups were well balanced with respect to demographic and clinical aspects. Stroke severity on admission (NIH Stroke Scale 10.0 ± 6.7 vs 11.3 ± 6.5), 3-month degree of independence on modified Rankin Scale (2 [interquartile range (IQR) 1.0-4.0] vs 3 [IQR 1.0-4.0]), as well as mortality (12.5% vs 18%) were significantly lower in the MET+ group. The frequency of symptomatic intracerebral hemorrhages did not differ between groups. HbA1c levels were well-balanced between the groups. CONCLUSIONS: Patients with stroke and diabetes on treatment with MET receiving IVT had less severe strokes on admission and a better functional outcome at 3 months. This suggests a protective effect of MET resulting in less severe strokes as well as beneficial thrombolysis outcome.
AB - OBJECTIVE: To evaluate whether pretreatment with metformin (MET) is associated with less stroke severity and better outcome after IV thrombolysis (IVT), we analyzed a cohort of 1,919 patients with stroke with type 2 diabetes mellitus in a multicenter exploratory analysis. METHODS: Data from patients with diabetes and ischemic stroke treated with IVT were collected within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration. We applied propensity score matching (PSM) to obtain balanced baseline characteristics of patients treated with and without MET. RESULTS: Of 1,919 patients with stroke with type 2 diabetes who underwent IVT, 757 (39%) had received MET before stroke (MET+), whereas 1,162 (61%) had not (MET-). MET+ patients were younger with a male preponderance. Hypercholesterolemia and pretreatment with statins, antiplatelets, or antihypertensives were more common in the MET+ group. After PSM, the 2 groups were well balanced with respect to demographic and clinical aspects. Stroke severity on admission (NIH Stroke Scale 10.0 ± 6.7 vs 11.3 ± 6.5), 3-month degree of independence on modified Rankin Scale (2 [interquartile range (IQR) 1.0-4.0] vs 3 [IQR 1.0-4.0]), as well as mortality (12.5% vs 18%) were significantly lower in the MET+ group. The frequency of symptomatic intracerebral hemorrhages did not differ between groups. HbA1c levels were well-balanced between the groups. CONCLUSIONS: Patients with stroke and diabetes on treatment with MET receiving IVT had less severe strokes on admission and a better functional outcome at 3 months. This suggests a protective effect of MET resulting in less severe strokes as well as beneficial thrombolysis outcome.
UR - http://www.scopus.com/inward/record.url?scp=85088850095&partnerID=8YFLogxK
U2 - https://doi.org/10.1212/WNL.0000000000009951
DO - https://doi.org/10.1212/WNL.0000000000009951
M3 - Article
C2 - 32601121
SN - 0028-3878
VL - 95
SP - e362-e373
JO - Neurology
JF - Neurology
IS - 4
ER -