{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:31:57Z","timestamp":1740130317918,"version":"3.37.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2020,8,8]],"date-time":"2020-08-08T00:00:00Z","timestamp":1596844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100008903","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW109-TDU-B-212-114004"],"award-info":[{"award-number":["MOHW109-TDU-B-212-114004"]}],"id":[{"id":"10.13039\/100008903","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Children\u2019s Hospital of China Medical University","award":["DMR-108-045"],"award-info":[{"award-number":["DMR-108-045"]}]},{"DOI":"10.13039\/501100004391","name":"China Medical University Hospital","doi-asserted-by":"publisher","award":["DMR-109-027","DMR-109-175"],"award-info":[{"award-number":["DMR-109-027","DMR-109-175"]}],"id":[{"id":"10.13039\/501100004391","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Academia Sinica Stroke Biosignature Project","award":["BM10701010021"],"award-info":[{"award-number":["BM10701010021"]}]},{"name":"MOST Clinical Trial Consortium for Stroke","award":["MOST 109-2321-B-039-002"],"award-info":[{"award-number":["MOST 109-2321-B-039-002"]}]},{"name":"Tseng-Lien Lin Foundation"},{"name":"Katsuzo and Kiyo Aoshima Memorial Funds"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: \u226560, and &amp;lt;60\u2009ml\/min\/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale \u22652) was calculated for patients with tPA treatment (N\u2009=\u2009705), compared to those without tPA treatment (N\u2009=\u20092820), by eGFR levels, at 1, 3 and 6\u2009months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among patients with eGFR levels of &amp;lt;60\u2009ml\/min\/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42\u20130.87) at 6\u2009months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/qjmed\/hcaa237","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T19:16:28Z","timestamp":1596568588000},"page":"848-856","source":"Crossref","is-referenced-by-count":0,"title":["Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction"],"prefix":"10.1093","volume":"114","author":[{"given":"I-K","family":"Wang","sequence":"first","affiliation":[{"name":"From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan"},{"name":"Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan"},{"name":"Division of Nephrology, China Medical University Hospital, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0907-1505","authenticated-orcid":false,"given":"T -H","family":"Yen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan"},{"name":"Chang Gung University College of Medicine, Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C -H","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan"},{"name":"Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S -P","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y","family":"Sun","sequence":"additional","affiliation":[{"name":"Neurology, En Chu Kong Hospital, New Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L -M","family":"Lien","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan"},{"name":"Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W -L","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T -C","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P -L","family":"Chen","sequence":"additional","affiliation":[{"name":"Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C -C","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, St Martin De Porres Hospital, Chiayi City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P -H","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cathay General Hospital, Taipei, Taiwan"},{"name":"Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C -H","family":"Lin","sequence":"additional","affiliation":[{"name":"Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y -C","family":"Su","sequence":"additional","affiliation":[{"name":"Management Office for Health Data"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M -C","family":"Lin","sequence":"additional","affiliation":[{"name":"Management Office for Health Data"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C -Y","family":"Li","sequence":"additional","affiliation":[{"name":"From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan"},{"name":"Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9435-5213","authenticated-orcid":false,"given":"F -C","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration, China Medical University College of Public Health, Taichung 404, Taiwan"},{"name":"Department of Food Nutrition and Health Biotechnology, Asia University, Lioufeng Road, Wufeng, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C Y","family":"Hsu","sequence":"additional","affiliation":[{"name":"From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Taiwan Stroke Registry Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,8,8]]},"reference":[{"key":"2022011215591004600_hcaa237-B1","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1161\/STROKEAHA.111.621904","article-title":"Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead","volume":"42","author":"Towfighi","year":"2011","journal-title":"Stroke"},{"key":"2022011215591004600_hcaa237-B2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5853\/jos.2014.16.2.59","article-title":"Stroke: morbidity, risk factors, and care in Taiwan","volume":"16","author":"Hsieh","year":"2014","journal-title":"J Stroke"},{"key":"2022011215591004600_hcaa237-B3","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1053\/j.ajkd.2007.12.017","article-title":"CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004","volume":"51","author":"McCullough","year":"2008","journal-title":"Am J Kidney Dis"},{"key":"2022011215591004600_hcaa237-B4","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1056\/NEJMoa041031","article-title":"Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization","volume":"351","author":"Go","year":"2004","journal-title":"N Engl J Med"},{"key":"2022011215591004600_hcaa237-B5","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1161\/STROKEAHA.116.014601","article-title":"Renal dysfunction is associated with poststroke discharge disposition and in-hospital mortality: findings from get with the guidelines-stroke","volume":"48","author":"El Husseini","year":"2017","journal-title":"Stroke"},{"key":"2022011215591004600_hcaa237-B6","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.atherosclerosis.2017.11.029","article-title":"Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke","volume":"269","author":"Wang","year":"2018","journal-title":"Atherosclerosis"},{"key":"2022011215591004600_hcaa237-B7","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.atherosclerosis.2018.07.033","article-title":"Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke","volume":"277","author":"Wang","year":"2018","journal-title":"Atherosclerosis"},{"key":"2022011215591004600_hcaa237-B8","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.atherosclerosis.2015.01.038","article-title":"Low estimated glomerular filtration rate is associated with poor outcomes in patients who suffered a large artery atherosclerosis stroke","volume":"239","author":"Yeh","year":"2015","journal-title":"Atherosclerosis"},{"key":"2022011215591004600_hcaa237-B9","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1161\/hs0202.102599","article-title":"ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke","volume":"33","author":"Albers","year":"2002","journal-title":"Stroke"},{"key":"2022011215591004600_hcaa237-B10","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0140-6736(98)08020-9","article-title":"Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators","volume":"352","author":"Hacke","year":"1998","journal-title":"Lancet"},{"key":"2022011215591004600_hcaa237-B11","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1056\/NEJM199512143332401","article-title":"Tissue plasminogen activator for acute ischemic stroke","volume":"333","year":"1995","journal-title":"N Engl J Med"},{"key":"2022011215591004600_hcaa237-B12","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/j.1525-139X.2008.00556.x","article-title":"Treatment of bleeding in dialysis patients","volume":"22","author":"Galbusera","year":"2009","journal-title":"Semin Dial"},{"key":"2022011215591004600_hcaa237-B13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000345071","article-title":"Renal impairment reduces the efficacy of thrombolytic therapy in acute ischemic stroke","volume":"35","author":"Power","year":"2013","journal-title":"Cerebrovasc Dis"},{"key":"2022011215591004600_hcaa237-B14","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1161\/CIRCULATIONAHA.110.936526","article-title":"Get With the Guidelines-Stroke performance indicators: surveillance of stroke care in the Taiwan Stroke Registry: get With the Guidelines-Stroke in Taiwan","volume":"122","author":"Hsieh","year":"2010","journal-title":"Circulation"},{"key":"2022011215591004600_hcaa237-B15","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2022011215591004600_hcaa237-B16","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1007\/s40620-014-0087-7","article-title":"Calibration and precision of serum creatinine and plasma cystatin C measurement: impact on the estimation of glomerular filtration rate","volume":"27","author":"Delanaye","year":"2014","journal-title":"J Nephrol"},{"key":"2022011215591004600_hcaa237-B17","doi-asserted-by":"crossref","first-page":"496","DOI":"10.5858\/arpa.2012-0134-CP","article-title":"Recent trends in performance and current state of creatinine assays","volume":"137","author":"Killeen","year":"2013","journal-title":"Arch Pathol Lab Med"},{"key":"2022011215591004600_hcaa237-B18","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1161\/STROKEAHA.117.017808","article-title":"Influence of renal impairment on outcome for thrombolysis-treated acute ischemic stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) post hoc analysis","volume":"48","author":"Carr","year":"2017","journal-title":"Stroke"},{"key":"2022011215591004600_hcaa237-B19","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1212\/01.wnl.0000435550.83200.9e","article-title":"IV thrombolysis and renal function","volume":"81","author":"Gensicke","year":"2013","journal-title":"Neurology"},{"key":"2022011215591004600_hcaa237-B20","doi-asserted-by":"crossref","first-page":"e286","DOI":"10.1097\/MD.0000000000000286","article-title":"Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis","volume":"93","author":"Hao","year":"2014","journal-title":"Medicine (Baltimore)"},{"key":"2022011215591004600_hcaa237-B21","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1212\/01.wnl.0000338459.82173.78","article-title":"Renal function and outcome among stroke patients treated with IV thrombolysis","volume":"71","author":"Lyrer","year":"2008","journal-title":"Neurology"},{"key":"2022011215591004600_hcaa237-B22","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1159\/000321516","article-title":"Reduced estimated glomerular filtration rate is associated with stroke outcome after intravenous rt-PA: the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry","volume":"31","author":"Naganuma","year":"2011","journal-title":"Cerebrovasc Dis"},{"key":"2022011215591004600_hcaa237-B23","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1161\/CIRCOUTCOMES.114.001144","article-title":"Chronic kidney disease and bleeding complications after intravenous thrombolytic therapy for acute ischemic stroke","volume":"7","author":"Ovbiagele","year":"2014","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2022011215591004600_hcaa237-B24","doi-asserted-by":"crossref","first-page":"3217","DOI":"10.1161\/STROKEAHA.113.002859","article-title":"Severe renal impairment is associated with symptomatic intracerebral hemorrhage after thrombolysis for ischemic stroke","volume":"44","author":"Tutuncu","year":"2013","journal-title":"Stroke"},{"key":"2022011215591004600_hcaa237-B25","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000346727","article-title":"Stroke features and management in patients with chronic kidney disease","volume":"179","author":"Kamouchi","year":"2013","journal-title":"Contrib Nephrol"},{"key":"2022011215591004600_hcaa237-B26","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1053\/j.ackd.2008.07.006","article-title":"Risks and benefits of antiplatelet therapy in uremic patients","volume":"15","author":"Washam","year":"2008","journal-title":"Adv Chronic Kidney Dis"},{"key":"2022011215591004600_hcaa237-B27","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1161\/STROKEAHA.111.639211","article-title":"Systematic review of outcome after ischemic stroke due to anterior circulation occlusion treated with intravenous, intra-arterial, or combined intravenous+intra-arterial thrombolysis","volume":"43","author":"Mullen","year":"2012","journal-title":"Stroke"}],"container-title":["QJM: An International Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/qjmed\/advance-article-pdf\/doi\/10.1093\/qjmed\/hcaa237\/33774787\/hcaa237.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/114\/12\/848\/42113960\/hcaa237.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/qjmed\/article-pdf\/114\/12\/848\/42113960\/hcaa237.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T16:02:05Z","timestamp":1642003325000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/qjmed\/article\/114\/12\/848\/5889961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,8]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,8,8]]},"published-print":{"date-parts":[[2022,1,9]]}},"URL":"https:\/\/doi.org\/10.1093\/qjmed\/hcaa237","relation":{},"ISSN":["1460-2725","1460-2393"],"issn-type":[{"type":"print","value":"1460-2725"},{"type":"electronic","value":"1460-2393"}],"subject":[],"published-other":{"date-parts":[[2021,12,1]]},"published":{"date-parts":[[2020,8,8]]}}}