Background:
Current ASA guidelines do not recommend increasing the dose of intravenous tissue plasminogen activator (IV rt-PA) for acute ischemic stroke patients weighing >100 kg. However, the consequences of such potential under-dosing may mean that it is less effective or even less harmful.
Objective:
To determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA.
Methods:
We identified patients who received IV recombinant tissue plasminogen activator (rt-PA) at 35 hospitals participating in the Michigan Coverdell Acute Stroke Registry from January2009 to December 2011. All ischemic strokes treated within 4.5 hours with non-missing BMI data were included in the analysis. Patient BMI was dichotomized as obese (BMI ≥30) or non-obese (BMI <30). Outcome measures included symptomatic intracerebral hemorrhage (sICH), in-hospital death, complications, length of stay (LOS) and discharge to home. The independent effects of obesity on outcomes were analyzed using logistic regression analysis with adjustment for age, gender, race and medical history.
Results:
Of 698 AIS patients who received IV rt-PA 536 (76.7%) had information on BMI recorded. Among those, 263 (37.7%) were obese. Compared to non-obese patients, obese patients were more likely to be women (57.8% vs. 44.6% p=0.0007), be younger (mean age 64.0 vs. 69.7 p<0.0001), and have hypertension and diabetes mellitus. Obese patients had longer LOS (mean 7.0 vs. 5.8 days, p=0.009) and were more likely to develop urinary tract infections (6.3 % vs. 11.3 %; p=0.009). In a multivariate regression model adjusting for age, gender, race medical comorbidities, obese to non-obese patients rates of sICH (OR, 95% CI 1.2 (0.47- 3.2), p= 0.68, death [OR, 95% CI 1.2 (0.56- 2.8),p=0.60] and discharge to home [OR, 95% CI 1.0 (0.69- 1.5), p=0.89)were all similar.
Conclusion:
Obese patients receiving IV t-PA treatment for acute ischemic stroke had similar rates of in-hospital mortality, discharge to home and sICH, but they had longer LOS and rates of UTI. Future studies should be undertaken to determine if the clinical efficacy of tPA is affected by under-dosing focusing on both radiographic recanalization rates and functional clinical outcomes.
Risk of pneumonia associated with zero‐degree head positioning in acute ischemic stroke patients treated with intravenous tissue plasminogen activator
