Abstract Details

Title Prior Intravenous Thrombolytics Administration is Associated with Increased Hospital Bills & Intracranial Hemorrhage Rates Without Improved Outcomes in Mechanical Thrombectomy Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-013

Objective To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo EVT alone and patients who undergo EVT with IV TPA.

Background The efficacy of intravenous thrombolytics (IV TPA) administration in conjunction with endovascular treatment (EVT) has recently come into question. If IV TPA does not offer significant patient outcome benefits nor significantly reduce rates of endovascular complications, its additional cost may present as an unnecessary financial burden.

Design/Methods We retrospectively grouped patients in an EVT database into those who underwent EVT and those who underwent EVT+IV TPA. Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (i.e. negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge NIHSS score, and functional independence data (mRS 0-2) were collected. Univariate and bivariate statistical analyses were performed.

Results Of 254 total patients, 96 (37.8%) underwent EVT+IV TPA. Median NIHSS score at admission was significantly higher in the EVT+IV TPA group than the EVT group (p = 0.006). After adjusting for NIHSS admission score, EVT+IVTPA patient bills and encounter charges were still found to be $3,861.64 (95% CI: $658.84 - 7,064.45, p = 0.02) and $103,946.37 (95% CI: $76,717.21 - $131,174.97, p = 0.001) greater than the EVT only group respectively. The EVT+IV TPA group had a higher complication rate of intracranial hemorrhage (ICH) (p = 0.005). EVT and EVT+IV TPA groups did not significantly differ in median discharge NIHSS score (p = 0.56), in functional independence rate at 90 days (p = 0.96), nor in average hospital stay length (p = 0.21).

Conclusions Patients undergoing EVT + IV TPA are associated with greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo EVT only.

Authors/Disclosures
Ameer Hassan, DO (Valley Baptist Medical Center) PRESENTER	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Wondwossen G. Tekle, MD	Dr. Tekle has nothing to disclose.
Amrou Sarraj, MD	Dr. Sarraj has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker Neurovascular. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Stryker Neurovascular. The institution of Dr. Sarraj has received research support from Stryker Neurovascular.
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.

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