In this article, the researchers are looking at outcomes for ischemic stroke patients who received recombinant tissue plasminogen activator aka rtPA aka the “Clot Buster.” And they want to know if these outcomes are predictable based on pre-rtPA administration via white blood cell (WBC) differential.
The outcomes they used are sICH (Which I could not figure out what it is. Anyone else?) “death” (oh dear) and the Modified Rankin Scale scores (looking for 0-2 scores as acceptable outcomes). Then they drew blood from each of the 846 patients prior to administration of rtPA. They found that high neutrophil count and high neutrophil to lymphocyte ratio were associated with worse outcomes.
The researchers were conservative in saying that their work has several limitations including: not knowing how many of those patients had recently had an infection or fever (which would elevate all WBCs) and is related to poor outcomes in stroke anyway. They also respectfully request more research be done in this area to determine it’s clinical value.
I find this interesting as a clinician. I always gets excited when I see in my acute stroke patient’s immediate medical history that they had been treated with rtPA. It really is a miracle drug. However, I have seen several that say something like “ischemic stroke with conversion to hemorrhagic after receiving rtPA.” And honestly those are some of the worst functional outcomes I see. If we can figure out an inexpensive way to filter out people who are probably going to end up with conversions, we could possibly save some function. Of course the middle cerebral artery (MCA) ischemic strokes are probably next in line for poorest functional outcomes in my mind, but hey, one step up the functional ladder can make or break a case sometimes.