Abstract P13: Faster Treatment Speed is Not Associated With Bleeds: Intravenous Alteplase Treatment in the Ultra-Early Time Window is Safe

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Provencher ◽  
Ashley Scherman ◽  
Elizabeth Baraban ◽  
Robert Jackson ◽  
Tamela L Stuchiner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Statistical Significance ◽  
Hospital Length Of Stay ◽  
Bleeding Complications ◽  
Stroke Patients ◽  
Related Complication ◽  
Discharge Disposition ◽  
Significant Difference

Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications. Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history. Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance. Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.

Abstract 3730: Length Of Hospitalization And Discharge Disposition Among Acute Ischemic Stroke Patients With Moderate To Severe Stroke by Treatment

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Steven A Koehler ◽  
Maxim Hammer ◽  
Vivek Reddy ◽  
Houhammad Jumaa ◽  
Syed Zaidi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Treatment Modality ◽  
Cerebral Arteries ◽  
Stroke Patients ◽  
Term Care ◽  
Severe Stroke ◽  
Discharge Disposition ◽  
Significant Difference

Background: Data regarding length of stay and discharge disposition in patients with moderate to severe stroke are scarce. We sought to determine Length of Stay (LoS) in a consecutive group of patients admitted at a large academic center and assess for any possible difference in LoS at discharge by treatment modality received and by vessels occlusion status. Methods: Retrospective review of a database comprising acute ischemic stroke patients admitted to our center between 1/1/2009-3/31/2011. Patient Demographics, treatment modality (IV thrombolytic tissue plasminogen activator (IVtPA), Endovascular (IA), no thrombolytic (NT), LoS, occlusion of major cerebral arteries and discharge disposition were collected. Inclusion criteria were AIS with admission NIHSS ≥10. Results: A total of 744 patients 361 (48.5%) male, mean age 69.9 years were identified. Treatment modalities: 174 (23%) IVtPA, 177 (24%) IA, 393 (53%) NT. Median NIHSS 16.5 and not significant among the 3 groups (P=.603). Mean LoS was 7.38 days (SD 7.4) with no significant difference between the 3 groups (P=.056). Occlusion to one of the 3 cerebral arteries (ICA, MCA, BA) was: 84% in IVtPA, 100% in IA, 87% in NT. Discharge disposition and LoS by treatment and occlusions are shown in the Table . Among patients treated with IVtPA (n=174) mean LoS was 6.33 days (range 1-27). LoS was significantly longer among those without occlusion vs with any occlusion (P=.001). Among patients that received IA (n=177) mean LoS was 8.21 days (range 0-74). Among patients received NT (n=393) the mean LoS was 7.47 days (range 0-64). Conclusions: Thrombolytic therapy (IV or EV) in patients with strokes is not associated with longer hospitalizations duration. A significant difference between death rates in patients receiving IA thrombolytic (22%) compared to IV (32%) or NT (30%) was found with fewer death among those that received IA (P= .008). Patients discharged to long term care facilities have regardless of treatment longer LoS (12.41v 6.14) (P>.000).

Abstract TP16: Short-Term Thrombectomy Outcomes Beyond the Traditional 6-Hour Time Window: Analysis of a Multi-Hub Telestroke Network

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Archit Bhatt ◽  
Lindsay Lucas ◽  
Elizabeth Baraban
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracranial Hemorrhage ◽  
Time Window ◽  
Stroke Patients ◽  
Short Term ◽  
Real World Data ◽  
Term Outcome ◽  
Discharge Disposition ◽  
Significant Difference

Background/Purpose: Acute ischemic stroke patients with large vessel occlusions are traditionally treated with thrombectomy within a 6-hour time window. Often patients get groin punctures for thrombectomy beyond 6 hours. The purpose of our study is to report real world data comparing short-term outcome differences in patients who receive groin punctures within 6 hours versus beyond 6 hours in a multi-hub telestroke network. Method: Data obtained from the Providence Health and Services Get With the Guidelines stroke registry were used to identify AIS patients who received intra-arterial (IA) intervention and were discharged from the hospital between November 2014 and May 2016. Patients were categorized as having Last Known Well-to-Groin-Puncture times (LKW-to-GP) over six hours or LKW-to-GP below or equal to six hours. Outcomes were modified rankin score (mRS) at discharge (slight or no disability versus moderate disability to dead), discharge disposition (home versus not home), change in NIHSS from admittance to discharge, and length of stay (LOS). Multivariate analyses were used to determine impact of the LKW-to-GP group on outcomes adjusting for post thrombolysis in cerebral infarction (TICI) grade, pre-symptom onset mRS, and admission NIHSS score. Intracranial hemorrhage rates were compared between the two groups using Fisher’s exact test. Results: We identified 136 ischemic stroke patients, 46.3% female with a mean age of 70.7 years (±14.6), who received IA intervention and were discharged between November 2014 and May 2016. Of those, 21% (n=29) had LKW-to-GP below or equal to six hours and 79% (n=107) had LKW-to-GP above six hours. After adjusting for covariates, there were no statistically significant differences in discharge mRS (p=.284), discharge disposition (p=.736), length of stay (p=.473) and change in NIHSS (p=.135). Unadjusted intracranial hemorrhage rates (p=.101) between the two LKW-to-GP groups were also not significant. Conclusions: We discovered one in five patients were treated beyond the traditional time window in a multi-hub telestroke network. We found no statistically significant difference in short term outcomes in patients receiving thrombectomy beyond 6 hours compared to those receiving thrombectomy within 6 hours.

scholarly journals Transitions of Care Coordination Intervention Identifies Barriers to Discharge in Hospitalized Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
William Denney Zimmerman ◽  
Rachel E. Grenier ◽  
Sydney V. Palka ◽  
Kelsey J. Monacci ◽  
Amanda K. Lantzy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Usual Care ◽  
Acute Ischemic Stroke ◽  
Transitions Of Care ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Stroke Patients ◽  
Significant Difference ◽  
Nurse Navigator ◽  
Prolonged Hospital

Background: Prolonged hospital lengths of stay increase costs, delay rehabilitation, and expose acute ischemic stroke patients to hospital-acquired infections. We designed and implemented a nurse-driven transitions of care coordinator (TOCC) program to facilitate the transition of care from the acute care hospital setting to rehabilitation centers and home.Methods: This was a single-blinded, prospective, randomized pilot study of 40 participants to evaluate the feasibility of implementing a TOCC program led by a stroke nurse navigator in hospitalized acute ischemic stroke patients. The intervention consisted of a stroke nurse navigator completing eight specific tasks, including meeting with stroke patients and their families, facilitating communication between team members at multi-disciplinary rounds, assisting with referrals to rehabilitation facilities, providing stroke education, and arranging stroke clinic follow-up appointments, which were confirmed to be completed by independent study personnel. The primary outcome was to assess the feasibility of the program. The secondary outcomes included comparing hospital length of stay (LOS) and patient satisfaction between the TOCC and usual care groups. We also explored the association between patient-level variables and LOS.Results: The TOCC program was feasible with all pre-specified components completed in 84.2% (95% CI: 60.4–96.6%) and was not significantly different from the assumed completion rate of 75% (p = 0.438). There was no significant difference in median LOS between the two groups [TOCC 5.95 days (4.02, 9.57) vs. usual care 4.01 days (2.00, 10.45), false discovery rate (FDR)-adjusted p = 0.138]. There was a trend toward higher patient median satisfaction in the TOCC group [TOCC 35.00 (33.00, 35.00) vs. usual care 30 (26.00, 35.00), FDR-adjusted p = 0.1] as assessed by a questionnaire at 30 days after discharge. The TOCC study allowed us to identify patient variables (gender, insurance, stroke severity, and discharge disposition) that were significantly associated with longer hospital LOS.Conclusion: A TOCC program is feasible and can serve as a guide for future allocation of resources to facilitate transitions of care and avoid prolonged hospital stays.

Abstract T P298: Impact of Accurate Weight Based Dosing of IV tPA in Acute Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vishal B Jani ◽  
Sopan Lahewala ◽  
Shilpkumar Arora ◽  
Erin Shell ◽  
Anmar Razak ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Stroke Severity ◽  
Fisher Exact Test ◽  
Weight Estimation ◽  
Stroke Patients ◽  
Significant Difference ◽  
Iv Tpa

Background: Accurate weight-based dosing is essential for efficacy and safety of thrombolysis in acute ischemic stroke (AIS). Stroke patients may be unable to communicate correct body weight (BW). Dosing may be estimated which can lead to error. Objective: To assess accuracy of weight estimation and the effect of weight and dosing discrepancy on outcome of patients with AIS Methods: 94 patients receiving IV tpa for AIS in a CSC registry between Feb, 2013 and Jul, 2014 were reviewed. All were given estimated weight based tPA- per patient input or agreement of 2 providers in ER. Accurate weights were obtained and recorded later. Actual weight was used to calculate the ideal TPA doses and compared to the weights and doses used. The cohort was separated into two groups based on weight discrepancy to those 10 kg (non forgiven) discrepancy. Rate of hemorrhage, NIHSS and hospice/mortality were assessed. Difference between categorical variables was tested using the chi-square and Fisher’ Exact Test. Differences between continuous variables were tested using Wilcoxon Rank Sum test and presented with median and IQ range. Results: 86.1% (forgiven cohort) were given the optimal tPA dose despite estimation. There was a significant difference in stroke severity based on admission NIHSS between the cohorts (33.3% in forgiven vs. 69.2% non-forgiven. P=0.04). Stroke severity based on discharge NIHSS did not reach statistical significance (mild: 71.8% vs 63.6%, moderate: 16.9% vs 9.1% and severe: 11.3% vs 27.3%, p = 0.32). 30 days modified Rankin Scale (mRS) was available for 52 pts without any significant difference (good outcome 44.4% vs 57.1%, poor outcome 35.6 % vs 28.6 %, p = 0.82). Statistically non significance toward higher rate of hemorrhagic conversion (6.4% vs 7.7%, p = 0.41), and higher mortality in non-forgiven group (7.41% vs 15.38%, p= 0.33). Conclusion: Accurate BW measurement prior tPA still remains challenging. In this study, weight estimation by 2 providers is fairly accurate. 14 % of the patients with discrepancy of > 10 kg had higher rate of mortality and hemorrhage although this was not statistically significant. Further studies with larger sample sizes are needed to examine the safety of weight estimation in AIS patients who receive IV tpa

Abstract WP447: Early Mobilization After 12 Hours Post-Thrombolysis is Safe and Reduces Length of Stay in Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Laurel Packard ◽  
Tricia Tubergen ◽  
Hattie LaCroix ◽  
Danielle Gritters ◽  
Nicholas Ames ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Bed Rest ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Patients ◽  
Discharge Disposition ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Background: Bed rest of 24 hours post-thrombolysis is recommended for acute ischemic stroke patients. We sought to compare outcomes and in-hospital complications of 12- and 24-hour bed rest protocols following thrombolysis in minor stroke patients. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and patients who underwent mechanical thrombectomy were excluded. The standard practice bed rest order for the 24 hour protocol prior to 07/15/2017 was compared with the 12 hour bed rest order protocol after that date. The primary outcome was length of stay. Secondary outcome measures included symptomatic intracerebral hemorrhage (sICH), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days and modified rankin scale (mRS) at 90 days. Results: Of the 106 patients identified, 36 patients were in the 24-hour protocol and 70 were in the 12-hour bed rest protocol group. There was significant difference for length of stay in the 24-hour bed rest protocol (2.9 days) compared with the 12-hour bed rest protocol (2.0 days) (p=0.032). Compared with the 24-hour bed rest group, the rates of sICH (p=NS), DVT (p=NS), PE (p=NS), pneumonia (p=NS), favorable discharge disposition (p=NS), 30 day readmission (p=0.NS) and 90 day mRS 0-2 (p=NS) were not different between the groups. Time to mobilization was significantly different between the two groups (24 hour group:2043.2 ± 680.1 minutes; 12 hour group:1221.0 ± 527.8) (p<0.0001). Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with significantly earlier patient mobilization and reduced length of stay without any adverse outcomes. A randomized trial is needed to verify these findings.

Abstract T P251: Factors for Delayed Medical Care Seeking among Elderly Stroke Patients in Korea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jeongha sim ◽  
Dongchoon Ahn ◽  
cha-nam shin
Keyword(s):  
Ischemic Stroke ◽  
Medical Care ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Care Seeking ◽  
Stroke Patients ◽  
Convenience Sample ◽  
Hospital Arrival ◽  
Stroke Education ◽  
Korean Elderly

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

Abstract TMP2: Is Eptifibatide a Viable and Safe Option as Stand-alone Therapy for Acute Ischemic Stroke Patients?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniel Korya ◽  
Mohammad Moussavi ◽  
Siddhart Mehta ◽  
Jaskiran Brar ◽  
Harina Chahal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
T Test ◽  
Bleeding Complications ◽  
Stroke Severity ◽  
Paired Samples ◽  
Group A ◽  
Group B ◽  
Iv Tpa

Introduction: The list of contraindications for IV tPA in acute ischemic stroke (AIS) is often too long and may lead to physicians opting to offer no treatment for certain strokes. An alternative treatment is proposed in cases where IV tPA is not an option due to time-window restrictions or contraindications. We compared the stroke severity, outcomes and safety of IV eptifibatide when compared with IV tPA. Methods: Patients who presented to a community based university affiliated comprehensive stroke center from 2012-15 with AIS over a two-year period were included in the study. Those who qualified for IV tPA, and were treated, were compared with patients who only received IV eptifibatide. The initial NIH Stroke Score (NIHSS), 24-hour NIHSS, discharge NIHSS (DCNIHSS), discharge mRS (DCmRS) and symptomatic ICH rates were compared with a paired samples t-test to determine significance of difference between the means. SPSS Version 22 was used for all data analysis. Results: A total of 864 patients presented with AIS in the evaluated time period and of those 166 met study criteria. There were 119 patients who received IV tPA alone (group A) and 47 patients received eptifibatide (group B). The mean initial NIHSS, 24-NIHSS, DCNIHSS, DCmRS and percent bleeding complications for group A were: 11.2, 10.8, 8.6, 3.1 and 6%. For group B the figures were: 6.7, 4.8, 4.3, 1.7 and 0%, respectively. Group A was compared with group B in a paired samples T-test and yielded -4.3, -6.2, -6, -1.5 (p=.0001 to .04) for initial, 24-hour, discharge NIHSS and discharge mRS, respectively. The difference between initial and discharge NIHSS between the two groups was -2.7 (p=.009), favoring IV tPA. Conclusion: In patients who are either outside the time-window or with contraindications to IV tPA, eptifibatide may be a safe alternative and appears to be efficacious. None of the patients who were started on eptifibatide had bleeding complications and they had a statistically significant improvement in their level of disability and stroke severity at discharge. A limitation of this study is that patients in group A had significantly worse initial NIHSS compared with group B. To better evaluate the efficacy of eptifibatide, a larger, prospective study should be initiated.

scholarly journals Triglyceride glucose index influences platelet reactivity in acute ischemic stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yinping Guo ◽  
Jing Zhao ◽  
Yi Zhang ◽  
Lingshan Wu ◽  
Zhiyuan Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Platelet Reactivity ◽  
Multivariate Logistic Regression Analysis ◽  
Platelet Inhibition ◽  
Inhibition Rate ◽  
Stroke Patients ◽  
Tyg Index ◽  
Significant Difference

Abstract Aim Insulin resistance was reported to increase the risk of ischemic stroke, which can be assessed by the triglyceride glucose (TyG) index. However, it remains unclear whether the TyG index influences the platelet reactivity during the treatment of ischemic patients. Methods Ischemic stroke patients receiving dual antiplatelet therapy (DAPT) within 48 h onset were consecutively included. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The top quartile of TyG index was defined as insulin resistance. The platelet reactivity was assessed by thromboelastography. The platelet inhibition rate induced by arachidonic acid (AA) or adenosine diphosphate (ADP) was used to confirm the high residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel, respectively. The association between TyG index and platelet reactivity was assessed by Kruskal–Wallis test. The independent risk factors of HRPR were determined by multivariate logistic regression analysis. Results A total of 1002 patients were included and divided into 4 groups by quartiles of the TyG index (< 2.02; 2.02–2.27; 2.27–2.52; ≥2.52). The findings demonstrated that the maximum intensity of the clot increased, but the AA-induced platelet inhibition rate decreased, depending on the TyG index quartiles. No significant difference was found in the ADP-induced platelet inhibition rate among groups. The prevalence of aspirin HRPR increased depending on the TyG index quartile. Unlike the non-insulin resistance group, the insulin resistance group was independently associated with aspirin HRPR (OR = 1.689, 95% CI 1.14 to 2.51, P = 0.009). Conclusions In acute ischemic stroke patients taking DAPT, the elevation of the TyG index is associated with enhanced platelet reactivity and higher prevalence of aspirin HRPR. Insulin resistance assessed by the TyG index could be an independent risk factor for aspirin HRPR.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

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