Abstract Details

Title Outcomes of Thrombolytic Treatment for Acute Ischemic Stroke in Dialysis Dependant Patients in the United States

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S02 - (-)

Poster/Presentation
Number 003

Objective

Background whether the relationship of renal function and outcome differs significantly between thrombolytics treated and non-thrombolytics treated patients undergoing dialysis still remains to be explored. Thrombolysis use in dialysis patients suffering from acute stroke has been an understudied subject.

Design/Methods We analyzed the data from Nationwide Inpatient Sample (NIS 2005-2008) for all thrombolytic treated patients presenting with acute ischemic stroke with or without dialysis dependence. Patients were identified using the ICD 9 CM codes. Baseline characteristics, inhospital complications including secondary intracerebral hemorrhage (ICH), DVT, UTI, sepsis, pneumonia, sepsis, pulmonary embolism and discharge outcomes (mortality, minimal disability, and moderate to severe disability) were compared between the groups.

Results Of the 82142 patients with ischemic stroke who receive thrombolytic treatment, 1072 (1.3%) was dialysis dependent. Out of 4215004 patients with ischemic stroke who did not receive thrombolytic treatment, 61400 (1.4%) were dialyses dependent. Baseline characteristics were mainly age, sex, race, medical comorbidities including hypertension, diabetes mellitus, presence of congestive heart failure and chronic lung diseases. The ICH rates did not differ significantly between patients with ischemic stroke with or without dialysis who received thrombolytics (5.2% vs 6.1%)The in-hospital mortality rate was higher in dialysis dependent patients treated with thrombolytics. (22% vs 11%) (P= <.0001). After adjusting for age and sex, and co morbidities, dialysis dependence was associated with higher rates of in-hospital mortality in patients treated with thrombolytics (odds ratio [OR], 2.47; 95% CI, 1.80-3.38 vs. odds ratio [OR], 3.06; 95% CI, 2.86-3.26).

Conclusions The three fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis dependant patients who present with acute ischemic stroke warrants a careful assessment of risk benefit ratio in this population.

Authors/Disclosures
Nauman Tariq, MD PRESENTER	Dr. Tariq has received personal compensation for serving as an employee of NC neurological society .
Muna Irfan, MD (VAMC)	Dr. Irfan has nothing to disclose.
	No disclosure on file
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.

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