Does metformin protect against stroke?

  • Westphal LP & al.
  • Neurology
  • 29 Jun 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Prior metformin use in patients with type 2 diabetes (T2D) who have strokes may result in lower stroke severity, better functional outcome, and lower mortality after intravenous thrombolysis (IVT).

Why this matters

  • Diabetes is a stroke risk factor and associated with more complications and less favorable clinical outcomes after thrombolysis.

Study design

  • Data from 1919 patients with T2D affected by ischemic stroke and treated with IVT were collected within the European Thrombolysis in Ischemic Stroke Patients collaboration.
  • Propensity score matching was applied to obtain balanced baseline characteristics of 757 patients treated with metformin (MET+) and 1162 without (MET−) prior to the stroke.
  • Funding: Swiss National Science Foundation; UZH Filling the Gap Foundation; Boehringer Ingelheim.

Key results

  • Mortality at 3 months in MET+ vs MET− groups was 12.5% vs 18.0% (P=.008).
  • National Institutes of Health Stroke Scale score on admission was lower in MET+ vs MET− patients (10.0 vs 11.3; P<.001 as was median modified rankin scale after months vs respectively>
  • No significant association found with MET dose.
  • No differences in symptomatic intracerebral hemorrhages.

Limitations

  • Observational.
  • Risk for bias from heterogeneity across centers.
  • Potential for unmeasured confounders.