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Stroke severity, early recovery and outcome are each related with clinical classification of stroke: data from the 'Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

Sprigg, Nikola; Gray, Laura J.; Bath, Philip M.W.; Lindenstrom, Ewa; Boysen, Gudrun; De Deyn, Peter Paul; Friis, Pal; Leys, Didier; Marttila, Reijo; Olsson, Jan-Edwin; O'Neill, Desmond; Ringelstein, Bernd

Stroke severity, early recovery and outcome are each related with clinical classification of stroke: data from the 'Tinzaparin in Acute Ischaemic Stroke Trial (TAIST) Thumbnail


Authors

NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine

Laura J. Gray

Philip M.W. Bath

Ewa Lindenstrom

Gudrun Boysen

Peter Paul De Deyn

Pal Friis

Didier Leys

Reijo Marttila

Jan-Edwin Olsson

Desmond O'Neill

Bernd Ringelstein



Abstract

Introduction: Baseline severity and clinical stroke syndrome (Oxford Community Stroke Project, OCSP) classification are predictors of outcome in stroke. We used data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST) to assess the relationship between stroke severity, early recovery, outcome and OCSP syndrome. Methods: TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1,484 patients with acute ischaemic stroke. Severity was measured as the Scandinavian Neurological Stroke Scale (SNSS) at baseline and days 4, 7 and 10, and baseline OCSP clinical classification recorded: total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) and posterior circulation infarction (POCI). Recovery was calculated as change in SNSS from baseline at day 4 and 10. The relationship between stroke syndrome
and SNSS at days 4 and 10, and outcome (modified Rankin scale at 90 days) were assessed.
Results: Stroke severity was significantly different between TACI (most severe) and LACI (mildest) at all four time points (p<0.001), with no difference between PACI and
POCI. The largest change in SNSS score occurred between baseline and day 4; improvement was least in TACI (median 2 units), compared to other groups (median 3 units) (p<0.001). If SNSS did not improve by day 4, then early recovery and late functional outcome tended to be limited irrespective of clinical syndrome (SNSS, baseline: 31, day 10: 32; mRS, day 90: 4); patients who recovered early tended to continue to improve and had better functional outcome irrespective of syndrome (SNSS, baseline: 35, day 10: 50; mRS, day 90: 2).
Conclusions: Although functional outcome is related to baseline clinical syndrome (best with LACI, worst with TACI), patients who improve early have a more favourable
functional outcome, irrespective of their OCSP syndrome. Hence, patients with a TACI syndrome may still achieve a reasonable outcome if early recovery occurs.

Citation

Sprigg, N., Gray, L. J., Bath, P. M., Lindenstrom, E., Boysen, G., De Deyn, P. P., Friis, P., Leys, D., Marttila, R., Olsson, J.-E., O'Neill, D., & Ringelstein, B. (2007). Stroke severity, early recovery and outcome are each related with clinical classification of stroke: data from the 'Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Journal of the Neurological Sciences, 254(1-2),

Journal Article Type Article
Publication Date Mar 15, 2007
Deposit Date Nov 21, 2007
Publicly Available Date Nov 21, 2007
Journal Journal of the Neurological Sciences
Print ISSN 0022-510X
Electronic ISSN 0022-510X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 254
Issue 1-2
Keywords tinzaparin, acute ischaemic Stroke
Public URL https://nottingham-repository.worktribe.com/output/704028
Publisher URL http://www.elsevier.com/wps/find/journaldescription.cws_home/506078/description#description