The impact of pre-stroke metformin use on clinical outcomes after acute ischemic stroke: A systematic review and meta-analysis

Madona Pakkam, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: madona.pakkam@gmail.com.
Atakan Orscelik, Department of Neurosurergy, University of California, San Francisco, San Francisco, California, United States. Electronic address: atakan.orscelik@ucsf.edu.
Basel Musmar, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: baselmusmar33@gmail.com.
Hatem Tolba, Department of Neurology, Medical College of Wisconsin, Wauwatosa, Wisconsin, United States. Electronic address: htolba@mcw.edu.
Sherief Ghozy, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: ghozy.sherief@mayo.edu.
Yigit Can Senol, Department of Neurosurergy, University of California, San Francisco, San Francisco, California, United States. Electronic address: yigitcan.senol@ucsf.edu.
Cem Bilgin, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: bilgin.cem@mayo.edu.
Sandeep Samethadka Nayak, Division of Hospital Medicine, Department of Internal Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, Connecticut, United States.
Ramanathan Kadirvel, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: kadir@mayo.edu.
Waleed Brinjikji, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: brinjikji.waleed@mayo.edu.
Alejandro A. Rabinstein, Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: rabinstein.alejandro@mayo.edu.
David F. Kallmes, Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: kallmes.david@mayo.edu.

Document Type

Article

Publication Title

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

Abstract

OBJECTIVES: Stroke is a leading cause of mortality and disability globally, with limited treatment options available for acute ischemic stroke (AIS) patients. Type 2 diabetes mellitus (T2DM) is not only widespread but also a known risk factor for stroke. Our meta-analysis aims to assess the influence of pre-stroke metformin use on the clinical outcomes in AIS patients with T2DM. MATERIALS AND METHODS: We conducted this study following PRISMA guidelines, searching the following databases: Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials up to February 29, 2024. All studies providing separate data on AIS patients using metformin were included, and statistical analysis was conducted using R software to pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). RESULTS: Out of 1051 studies, 7 met the inclusion criteria for our meta-analysis with a total of 11589 diabetic patients, including 5445 patients taking metformin and 6144 diabetic patients in the non-metformin group. Compared to the non-metformin group, the metformin group had a significantly higher rate of mRS 0-2 score at discharge (OR 1.56; 95% CI 1.25:1.95; p=< 0.01) and a lower rate of 90-day mortality (OR 0.51; 95% CI 0.42:0.61; p=< 0.01), with no significant difference in sICH (OR 0.88; 95% CI 0.47:1.64; p= 0.68) between the two groups. CONCLUSIONS: Our meta-analysis demonstrated that pre-stroke metformin use is associated with higher functional independence and lower mortality in AIS patients with T2DM.

First Page

107716

DOI

10.1016/j.jstrokecerebrovasdis.2024.107716

Publication Date

6-1-2024

Identifier

38604350 (pubmed); 10.1016/j.jstrokecerebrovasdis.2024.107716 (doi); S1052-3057(24)00161-7 (pii)

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