What are the associated clinical complications in post-stroke patients after 90 days, specifically regarding potential sequelae such as spasticity, dysphagia, or impaired cognitive function?

From the Guidelines

Post-stroke patients commonly experience several clinical complications after 90 days, including post-stroke depression, cognitive impairment, physical disabilities such as hemiparesis, spasticity, and contractures, which can significantly impact their quality of life and morbidity. These complications can be managed with a multidisciplinary approach, including physical therapy, occupational therapy, speech therapy, and appropriate medications for specific complications 1. The prevalence of post-stroke spasticity in any limb is in the range of 25% to 43% over the first year after stroke, and it is correlated with activity limitations associated with hygiene, dressing, and pain 1.

Some of the key clinical complications that post-stroke patients may experience after 90 days include:

• Post-stroke depression, affecting approximately 30% of survivors
• Cognitive impairment, ranging from mild deficits to dementia
• Physical disabilities, such as hemiparesis, spasticity, and contractures
• Central post-stroke pain syndrome, characterized by neuropathic pain in affected limbs
• Dysphagia, which persists in some patients and increases aspiration pneumonia risk
• Urinary incontinence, affecting about 15% of survivors at three months
• Fatigue, reported by up to 70% of patients, significantly impacting quality of life
• Seizures, which develop in 2-4% of patients within the first year
• Recurrent stroke risk, which is highest in the first 90 days but remains elevated long-term

Early identification and treatment of these complications can significantly improve outcomes and quality of life for post-stroke patients. A multidisciplinary approach to management, including physical therapy, occupational therapy, speech therapy, and appropriate medications for specific complications, is essential for optimizing patient outcomes 1. Additionally, assessment of the patient's capacity to perform activities of daily living is crucial for identifying areas of need and developing targeted interventions 1.

It is also important to note that the cost of care for post-stroke patients with spasticity is 4 times higher than for those without spasticity, highlighting the need for effective management of this complication 1. Furthermore, the use of botulinum toxin injections for upper limb spasticity combined with therapy may not be cost-effective compared with therapy alone, emphasizing the importance of careful consideration of treatment options 1.

Overall, post-stroke patients require comprehensive and ongoing care to manage the various clinical complications that can arise after 90 days, and a multidisciplinary approach to management is essential for optimizing patient outcomes and quality of life.

From the Research

Associated Clinical Complications in Post-Stroke Patients After 90 Days

• The study 2 found that patients who had a febrile event, higher mean temperature, finger-prick blood glucose reading ≥11 mmol/L, higher mean blood glucose, or failed the swallowing screen within the first 72 hours of stroke unit admission had lower odds of 90-day independence.
• The same study 2 also found that patients who had venous blood glucose taken on admission to hospital or within 2 hours of stroke unit admission, finger-prick blood glucose measured within 72 hours of stroke unit admission, or swallowing screening or assessment performed within 24 hours of stroke unit admission had greater odds of independence.
• A study 3 found that 7.54% of patients with mild ischemic stroke experienced worsening of functional status from 30 to 90 days post-stroke, while 17.33% improved.
• The study 3 also identified older age, greater stroke severity, and no alteplase treatment as predictors of functional decline from 30 to 90 days post-stroke.
• Another study 4 highlighted the importance of comprehensive and pragmatic programs operated by multidisciplinary stroke teams to reduce the long-term health burden of stroke, including post-stroke complications and residual deficits.

Post-Stroke Complications and Management

• The study 5 found that the use of non-vitamin K antagonist oral anticoagulants (NOACs) and antiplatelet therapy for stroke prevention in patients with atrial fibrillation was associated with an increased risk of bleeding, but no additional benefit in terms of stroke prevention.
• A mixed treatment comparison meta-analysis 6 found that warfarin and new anticoagulants were similar in reducing the risk of stroke, vascular death, and mortality, but warfarin was associated with more non-major bleeding events compared to apixaban.
• The study 4 emphasized the need for further high-quality studies to establish sustainable solutions for post-stroke patient management, including the management of post-stroke complications and residual deficits.