Abstract Details

Title Hemorrhagic Complications after Acute Stroke Therapies Are Not Elevated in Patients with Chronic Kidney Disease, with or without Hemodialysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-034

Objective To examine hemorrhagic risk post-thrombolysis and/or endovascular thrombectomy (ET) in acute ischemic stroke (AIS) patients with chronic kidney disease (CKD) with or without hemodialysis (HD).

Background CKD may increase risk of hemorrhage due to abnormal platelet function, altered endothelium, and reduction in inhibitors of blood coagulation. This has not adequately been investigated in patients with AIS post-acute intervention.

Design/Methods We performed a retrospective review of patients with AIS admitted to our comprehensive stroke center between January 2010 and July 2018. Patients with CKD treated with IV-tPA and/or ET were included. Stage of CKD and use of HD were recorded. Medical records were reviewed, using an increase in the NIHSS of at least 4 points to define sICH. CT images were assessed for hemorrhagic infarction (grades HI-1 and HI-2) and parenchymal hematoma (grades PH-1 and PH-2). Chi-square test or Fisher’s exact test was used to examine the relationship between CKD/HD and hemorrhage.

Results Out of 132 patients, sICH occurred at rates of 6.7%, 5.9% and 11.5%, for the IV-tPA, ET, and combined therapy groups, respectively. The total rate of hemorrhage was not significantly different between patients on HD and patients not on HD (19.1% vs 30.6%, p=0.28), nor were rates significantly different between groups when partitioned by sICH (9.5% vs 7.2%) and aICH (9.5% vs 23.42%), p=0.38. HD was not associated with hemorrhage grade for either sICH or aICH (p=1, p=0.64). There was no relationship between stage of renal disease and hemorrhage grade (p=0.75).

Conclusions Rates of sICH and aICH in AIS patients with CKD post-tPA, ET, or combined therapy were comparable to rates previously reported in major stroke treatment trials, some of which excluded patients with CKD. Though previously theorized, CKD may not confer greater risk of hemorrhage after IV-tPA, and/or ET. Furthermore, HD was not associated with increased rates of sICH or aICH.

Authors/Disclosures
Sarah Song, MD, MPH, FAAN (Rush University Medical Center) PRESENTER	Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.
Daniel M. Schachter, MD (Emory University - Grady Mem Hosp)	Dr. Schachter has nothing to disclose.
Micaela Schachter, MD (Emory University)	No disclosure on file
Bichun Ouyang	Bichum Ouyang has nothing to disclose.
Alejandro Vargas, MD, MS, FAAN (Rush University Medical Center)	Dr. Vargas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer U.S. LLC Pharmaceuticals.
Nicholas D. Osteraas, MD (Rush University Med Center)	Dr. Osteraas has nothing to disclose.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Lauren Koffman, DO, MS (Temple University Hospital)	Dr. Koffman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Law Firm. Dr. Koffman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Walters Kluwer.
Laurel J. Cherian, MD, FAAN (Rush University Medical Center)	The institution of Dr. Cherian has received research support from NIH.

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