Prognosis

In 2019, there were 6.5 million deaths from stroke worldwide. Stroke is a leading cause of serious long-term disability in the US and worldwide.[16][190] Prognosis of functional outcome can be reliably performed by well-validated prognostic scores like the ASTRAL score or the iScore.[191] Intravenous thrombolysis and dedicated stroke units are the only interventions shown to improve stroke outcome.

Common medical complications of stroke include aspiration pneumonia, depression, and deep vein thrombosis.

A meta-analysis study on the efficacy of physiotherapy following stroke found that a variety of interventions improved functional outcomes, even when they were applied late after stroke.[192]

Patients receiving alteplase

Patients treated with alteplase (if given within 4.5 hours of onset of symptoms) have a better functional outcome than patients not treated with alteplase. There is, however, an increased risk of intracerebral haemorrhage with alteplase; this does not seem to affect death or dependency at 3 months.[63][125][193]

Patients receiving tenecteplase

Tenecteplase within 4.5 hours of ischaemic stroke due to large vessel occlusion is non-inferior to alteplase in terms of excellent functional outcome (90-day modified Rankin Scale [mRS] scores of 0-1) and may be superior to alteplase in terms of good functional outcome (90-day mRS scores of 0-2), as supported by meta-analysis of several randomised controlled trials.[106][118][119][120][121]​​​​​[122]​​ Low-quality trial evidence suggests no significant differences in terms of mortality secondary to symptomatic intracerebral haemorrhage.[106]​ Tenecteplase is not recommended for patients with ischaemic stroke on awakening from sleep or of unknown onset who undergo no brain imaging other than computed tomography (CT). In a phase 3 randomised controlled trial of patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days versus the control group, and there was no difference in mortality between groups.[123]

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