Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial

The aim was to study the effect of intravenous alteplase on the development of post‐stroke depression (PSD) in acute stroke patients, and to identify predictors of PSD. Methods This post hoc analysis included patients with unknown onset stroke randomized to treatment with alteplase or placebo in the...

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Autores: Königsberg, Alina, Sehner, Susanne, Arlt, Sönke, Cheng, Bastian, Simonsen, Claus Z., Boutitie, Florent, Serena, Joaquín, Thijs, Vincent, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B., Lemmens, Robin, Muir, Keith W., Nighoghossian, Norbert, Pedraza, S., Gerloff, Christian, Thomalla, Götz, WAKE-UP Consortium
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10256/19545
Acceso en línea:http://hdl.handle.net/10256/19545
Access Level:acceso abierto
Palabra clave:Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
Atac isquèmic transitori
Transient ischemic attack
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spelling Effect of intravenous alteplase on post-stroke depression in the WAKE UP trialKönigsberg, AlinaSehner, SusanneArlt, SönkeCheng, BastianSimonsen, Claus Z.Boutitie, FlorentSerena, JoaquínThijs, VincentEbinger, MartinEndres, MatthiasFiebach, Jochen B.Lemmens, RobinMuir, Keith W.Nighoghossian, NorbertPedraza, S.Gerloff, ChristianThomalla, GötzWAKE-UP ConsortiumIsquèmia cerebral -- TractamentCerebral ischemia -- TreatmentAtac isquèmic transitoriTransient ischemic attackThe aim was to study the effect of intravenous alteplase on the development of post‐stroke depression (PSD) in acute stroke patients, and to identify predictors of PSD. Methods This post hoc analysis included patients with unknown onset stroke randomized to treatment with alteplase or placebo in the WAKE‐UP trial (ClinicalTrials.gov number, NCT01525290), in whom a composite end‐point of PSD was defined as a Beck Depression Inventory ≥10, medication with an antidepressant, or depression recorded as an adverse event. Multiple logistic regression was used to identify predictors of PSD at 90 days. Structural equation modelling was applied to assess the indirect effect of thrombolysis on PSD mediated by the modified Rankin Scale. Results Information on the composite end‐point was available for 438 of 503 randomized patients. PSD was present in 96 of 224 (42.9%) patients in the alteplase group and 115 of 214 (53.7%) in the placebo group (odds ratio 0.63; 95% confidence interval 0.43–0.94; p = 0.022; adjusted for age and National Institutes of Health Stroke Scale at baseline). Prognostic factors associated with PSD included baseline medication with antidepressants, higher lesion volume, history of depression and assignment to placebo. While 65% of the effect of thrombolysis on PSD were caused directly, 35% were mediated by an improvement of the mRS. Conclusions Treatment with alteplase in patients with acute stroke resulted in lower rates of depression at 90 days, which were only partially explained by reduced functional disability. Predictors of PSD including history and clinical characteristics may help in identifying patients at risk of PSDEuropean Union Seventh Framework. Grant Number: 278276Wiley2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionpeer-reviewedapplication/pdfhttp://hdl.handle.net/10256/19545http://hdl.handle.net/10256/19545European Journal of Neurology, 2021, vol.28, núm. 6, p. 2017-2025Articles publicats (IdIBGi)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)Inglésinfo:eu-repo/semantics/altIdentifier/doi/10.1111/ene.14797info:eu-repo/semantics/altIdentifier/issn/1351-5101info:eu-repo/semantics/altIdentifier/eissn/1468-1331info:eu-repo/grantAgreement/EC/FP7/278276Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10256/195452026-05-29T05:05:01Z
dc.title.none.fl_str_mv Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
title Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
spellingShingle Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
Königsberg, Alina
Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
Atac isquèmic transitori
Transient ischemic attack
title_short Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
title_full Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
title_fullStr Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
title_full_unstemmed Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
title_sort Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
dc.creator.none.fl_str_mv Königsberg, Alina
Sehner, Susanne
Arlt, Sönke
Cheng, Bastian
Simonsen, Claus Z.
Boutitie, Florent
Serena, Joaquín
Thijs, Vincent
Ebinger, Martin
Endres, Matthias
Fiebach, Jochen B.
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author Königsberg, Alina
author_facet Königsberg, Alina
Sehner, Susanne
Arlt, Sönke
Cheng, Bastian
Simonsen, Claus Z.
Boutitie, Florent
Serena, Joaquín
Thijs, Vincent
Ebinger, Martin
Endres, Matthias
Fiebach, Jochen B.
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author_role author
author2 Sehner, Susanne
Arlt, Sönke
Cheng, Bastian
Simonsen, Claus Z.
Boutitie, Florent
Serena, Joaquín
Thijs, Vincent
Ebinger, Martin
Endres, Matthias
Fiebach, Jochen B.
Lemmens, Robin
Muir, Keith W.
Nighoghossian, Norbert
Pedraza, S.
Gerloff, Christian
Thomalla, Götz
WAKE-UP Consortium
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
Atac isquèmic transitori
Transient ischemic attack
topic Isquèmia cerebral -- Tractament
Cerebral ischemia -- Treatment
Atac isquèmic transitori
Transient ischemic attack
description The aim was to study the effect of intravenous alteplase on the development of post‐stroke depression (PSD) in acute stroke patients, and to identify predictors of PSD. Methods This post hoc analysis included patients with unknown onset stroke randomized to treatment with alteplase or placebo in the WAKE‐UP trial (ClinicalTrials.gov number, NCT01525290), in whom a composite end‐point of PSD was defined as a Beck Depression Inventory ≥10, medication with an antidepressant, or depression recorded as an adverse event. Multiple logistic regression was used to identify predictors of PSD at 90 days. Structural equation modelling was applied to assess the indirect effect of thrombolysis on PSD mediated by the modified Rankin Scale. Results Information on the composite end‐point was available for 438 of 503 randomized patients. PSD was present in 96 of 224 (42.9%) patients in the alteplase group and 115 of 214 (53.7%) in the placebo group (odds ratio 0.63; 95% confidence interval 0.43–0.94; p = 0.022; adjusted for age and National Institutes of Health Stroke Scale at baseline). Prognostic factors associated with PSD included baseline medication with antidepressants, higher lesion volume, history of depression and assignment to placebo. While 65% of the effect of thrombolysis on PSD were caused directly, 35% were mediated by an improvement of the mRS. Conclusions Treatment with alteplase in patients with acute stroke resulted in lower rates of depression at 90 days, which were only partially explained by reduced functional disability. Predictors of PSD including history and clinical characteristics may help in identifying patients at risk of PSD
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
peer-reviewed
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10256/19545
http://hdl.handle.net/10256/19545
url http://hdl.handle.net/10256/19545
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1111/ene.14797
info:eu-repo/semantics/altIdentifier/issn/1351-5101
info:eu-repo/semantics/altIdentifier/eissn/1468-1331
info:eu-repo/grantAgreement/EC/FP7/278276
dc.rights.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv European Journal of Neurology, 2021, vol.28, núm. 6, p. 2017-2025
Articles publicats (IdIBGi)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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