We seek to evaluate the use and outcome of thrombolysis in patient with Down Syndrome (DS) compared to the general population. 

DS is a genetic disorder caused by trisomy 21. As this population ages, they are at higher risk of cardio embolic strokes due to association with congenital heart disease. There is scarce data regarding strokes in the DS population.

Nationwide Inpatient Sample (NIS) from 2005 to 2014 was utilized to identify DS patients using ICD CM code 758.0 in secondary diagnostic field and acute ischemic stroke (AIS) with appropriate diagnostic codes in primary field. Intravascular thrombolysis utilization was identified by ICD9 procedure code 99.10 in any procedural field. Differences between categorical variables were tested using the chi-square test and continuous variables using the Student t-test.

We identified 4332783 patients with AIS, 1333 (0.03%) also had a diagnosis of DS. Patients with DS and AIS were younger (45.6 vs 71.2; p<0.0001). Despite being younger and having less comorbid conditions, patients with ischemic stroke who have DS are less likely to receive thrombolysis than those without DS (3.67% vs 5.77%; p =0.001). Although, there was no statistically significant difference in the use of mechanical thrombectomy (MT). DS patients that received thrombolysis were more likely to be male (61.8% vs 38.2%; p=0.0011), and at a teaching hospital (p=0.0016). However, there was increased in-hospital mortality among those DS patients who received thrombolysis compared to the group without thrombolysis (20.5% vs. 5.7%; p=0.004).

Patients with DS and AIS have a decreased rate of thrombolysis, yet similar rates of MT. However, those DS patients that received thrombolysis had increased in-hospital mortality. We postulate that this may be secondary to increased beta-amyloid peptide accumulation and risk of cerebral amyloid angiopathy in DS. Thrombolysis in this population needs to be further studied.