Abstract Details

Title Illicit Drug Use - Contributing Factors for Lower tPA Treatment Rate Vary by Drug

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 248

Objective

Background BACKGROUND: Drug abuse may be the most common predisposing condition for stroke patients under 35 years. It is unknown whether delay in hospital presentation or increased frequency of unknown symptom onset time contributes to reported low rates of IV tPA use in patients.

Design/Methods DESIGN/METHODS: A retrospective review of prospectively identified patients with AIS from 7/2008-12/2010 was performed. We compared demographics, IV tPA treatment, time from last seen normal (LSN) to ED arrival, stroke severity and outcomes in patients with positive (tox+) vs negative (tox-) toxicology screen. Tox+ screen was defined as presence of one or more illicit drugs. We compared specific drugs with regard to the frequency of unknown LSN and time from LSN to ED arrival.

Results RESULTS: Toxicology screen was performed in 263/593 patients with AIS; 46% (n=121) had tox+ which was associated with age (58 vs 66; p<0.001), active smoking (49.1 vs 36.4%, p=0.040), and lower tPA use (21.7% vs 32.4% p=0.053) compared with tox-. Tox+ trends included higher mortality rate (10.9 vs 5.0%, p=0.075) and longer LSN to ED arrival interval (median 578 vs 253min, p=0.056). Cocaine was the only illicit associated with a significant prolongation in LSN to ED arrival time (median 802min vs 258min, p=0.016). Opiates were associated with increased frequency of an unknown LSN time (56% vs 23%, <=0.001). No difference in frequency of contraindication to tPA in tox+ vs tox- patients (34.8 vs 37.9%, p=0.623) was found.

Conclusions CONCLUSIONS: We found patients with AIS and recent illicit drug use were under-treated with IV tPA. Potential reasons for this include the delay in hospital presentation and stroke of unknown onset, but these phenomena may be drug-specific.

Authors/Disclosures
PRESENTER	No disclosure on file
Jacob S. Elkins, MD	No disclosure on file
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
Amir Shaban, MD (University of Iowa)	Dr. Shaban has nothing to disclose.
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
	No disclosure on file
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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