Alexander E Merkler1, Setareh Salehi Omran2, Gino Gialdini2, Michael P Lerario2, Shadi Yaghi2, Mitchell S V Elkind2, Babak B Navi2. 1. From the Department of Neurology (A.E.M., S.S.O., M.P.L., B.B.N.) and Brain and Mind Research Institute (A.E.M., S.S.O., G.G., M.P.L., B.B.N.), Weill Cornell Medicine, New York, NY; Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.); Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI (S.Y.); Department of Neurology, Columbia University School of Medicine, New York, NY (M.S.V.E.); and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.). alm9097@med.cornell.edu. 2. From the Department of Neurology (A.E.M., S.S.O., M.P.L., B.B.N.) and Brain and Mind Research Institute (A.E.M., S.S.O., G.G., M.P.L., B.B.N.), Weill Cornell Medicine, New York, NY; Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.); Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI (S.Y.); Department of Neurology, Columbia University School of Medicine, New York, NY (M.S.V.E.); and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
Abstract
BACKGROUND AND PURPOSE: It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes. METHODS: Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality. We used logistic regression to compare rates of outcomes in patients with and without previous ischemic stroke within 3 months of intravenous tPA for AIS. RESULTS: We identified 36 599 AIS patients treated with intravenous tPA, of whom 568 (1.6%) had a previous ischemic stroke in the past 3 months. Of all patients who received intravenous tPA, the rate of intracerebral hemorrhage was 4.9% (95% confidence interval [CI], 4.7%-5.1%), and death occurred in 10.7% (95% CI, 10.4%-11.0%). After adjusting for demographics, vascular risk factors, and the Elixhauser Comorbidity Index, previous ischemic stroke within 3 months of thrombolysis for AIS was not associated with an increased risk of intracerebral hemorrhage (odds ratio, 0.9; 95% CI, 0.6-1.4; P=0.62), but was associated with an increased risk of death (odds ratio, 1.5; 95% CI, 1.2-1.9; P=0.001) and unfavorable discharge disposition (odds ratio, 1.3; 95% CI, 1.0-1.7; P=0.04). CONCLUSIONS: Among patients who receive intravenous tPA for AIS, recent ischemic stroke is not associated with an increased risk of intracerebral hemorrhage but is associated with a higher risk of death and unfavorable discharge disposition.
BACKGROUND AND PURPOSE: It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes. METHODS: Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality. We used logistic regression to compare rates of outcomes in patients with and without previous ischemic stroke within 3 months of intravenous tPA for AIS. RESULTS: We identified 36 599 AIS patients treated with intravenous tPA, of whom 568 (1.6%) had a previous ischemic stroke in the past 3 months. Of all patients who received intravenous tPA, the rate of intracerebral hemorrhage was 4.9% (95% confidence interval [CI], 4.7%-5.1%), and death occurred in 10.7% (95% CI, 10.4%-11.0%). After adjusting for demographics, vascular risk factors, and the Elixhauser Comorbidity Index, previous ischemic stroke within 3 months of thrombolysis for AIS was not associated with an increased risk of intracerebral hemorrhage (odds ratio, 0.9; 95% CI, 0.6-1.4; P=0.62), but was associated with an increased risk of death (odds ratio, 1.5; 95% CI, 1.2-1.9; P=0.001) and unfavorable discharge disposition (odds ratio, 1.3; 95% CI, 1.0-1.7; P=0.04). CONCLUSIONS: Among patients who receive intravenous tPA for AIS, recent ischemic stroke is not associated with an increased risk of intracerebral hemorrhage but is associated with a higher risk of death and unfavorable discharge disposition.
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