Monday March 19, 2007
Acute hyperglycemia may lower tPA effect in stroke patients


As benefits of blood sugar control is getting more and more attention, this new study published in stroke 1 from spain is noteworthy which found that "acute" (but not chronic) hyperglycemia may lower tPA effect in stroke patients. As known from before, hyperglycemia has a deleterious effect in stroke patients by accelerating ischemic brain damage. This study showed that antifibrinolytic effect of hyperglycemia may also influence reperfusion.


Glucose level at admission was recorded in 139 consecutive stroke patients who were treated with intravenous tissue-type plasminogen activator (tPA). The existence of previous chronic hypergycemia was determined by glycosylated hemoglobin (HbA1c) and fructosamine.

• Transcranial Doppler monitoring assessed complete recanalization 2 hours after tPA bolus.
• National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 48 hours.

Results — Patients who recanalized showed lower admission glucose levels but no differences in HbA1c or fructosamine.

Patients with an admission glucose level more than 158 mg/dL had lower recanalization rates (16% vs 36.1%) and a higher NIHSS score at 48 hours (7 vs 14.5). After adjustment for stroke etiology, age, and risk factors, the only independent predictors on admission of no recanalization were

• glucose value more than 158 mg/dL,
• proximal middle cerebral artery occlusion and
• platelet count less than 219 000/mL

Study concluded that in tPA-treated patients, the acute but not chronic hyperglycemia state may hamper the fibrinolytic process, delaying reperfusion of the ischemic penumbra. Early measures to reduce blood glucose may favor early recanalization.


Reference: Click to get abstract

1. Acute Hyperglycemia State Is Associated With Lower tPA-Induced Recanalization Rates in Stroke Patients -Stroke. 2005;36:1705