2026-04-17T04:05:13Zhttps://recercat.cat/oai/request

oai:recercat.cat:10256/195452024-06-18T12:41:26Zcom_2072_452955com_2072_2054col_2072_453079

00925njm 22002777a 4500 dc Königsberg, Alina author Sehner, Susanne author Arlt, Sönke author Cheng, Bastian author Simonsen, Claus Z. author Boutitie, Florent author Serena, Joaquín author Thijs, Vincent author Ebinger, Martin author Endres, Matthias author Fiebach, Jochen B. author Lemmens, Robin author Muir, Keith W. author Nighoghossian, Norbert author Pedraza, S. author Gerloff, Christian author Thomalla, Götz author WAKE-UP Consortium author 2021-06 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 European Union Seventh Framework. Grant Number: 278276 http://hdl.handle.net/10256/19545 Isquèmia cerebral -- Tractament Cerebral ischemia -- Treatment Atac isquèmic transitori Transient ischemic attack Effect of intravenous alteplase on post-stroke depression in the WAKE UP trial