Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
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Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial. / Königsberg, Alina; Sehner, Susanne; Arlt, Sönke; Cheng, Bastian; Simonsen, Claus Z; Boutitie, Florent; Serena, Joaquin; Thijs, Vincent; Ebinger, Martin; Endres, Matthias; Fiebach, Jochen B; Lemmens, Robin; Muir, Keith W; Nighoghossian, Norbert; Pedraza, Salvador; Gerloff, Christian; Thomalla, Götz; WAKE-UP Investigators.
in: EUR J NEUROL, Jahrgang 28, Nr. 6, 06.2021, S. 2017-2025.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial
AU - Königsberg, Alina
AU - Sehner, Susanne
AU - Arlt, Sönke
AU - Cheng, Bastian
AU - Simonsen, Claus Z
AU - Boutitie, Florent
AU - Serena, Joaquin
AU - Thijs, Vincent
AU - Ebinger, Martin
AU - Endres, Matthias
AU - Fiebach, Jochen B
AU - Lemmens, Robin
AU - Muir, Keith W
AU - Nighoghossian, Norbert
AU - Pedraza, Salvador
AU - Gerloff, Christian
AU - Thomalla, Götz
AU - WAKE-UP Investigators
N1 - © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND AND PURPOSE: 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.
AB - BACKGROUND AND PURPOSE: 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.
U2 - 10.1111/ene.14797
DO - 10.1111/ene.14797
M3 - SCORING: Journal article
C2 - 33657675
VL - 28
SP - 2017
EP - 2025
JO - EUR J NEUROL
JF - EUR J NEUROL
SN - 1351-5101
IS - 6
ER -
