Abstract WP65: Outcomes Of Thrombolytic Treatment For Acute Ischemic Stroke In Dialysis Dependant Patients In The United States
Objective: To determine the outcomes of dialysis dependant patients who suffered from ischemic stroke and were treated with IV thrombolytics in United States
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.
- © 2012 by American Heart Association, Inc.