Abstract W P265: Improved Symptomatic ICH Rates for Ischemic Stroke Patients Receiving IV rtPA
Introduction: Symptomatic intracranial hemorrhage (sICH) is a concerning complication after the administration of IV r-tPA for treatment of acute ischemic stroke. Results from the NINDS trial demonstrated a 6.2% sICH rate. As such, acute stroke teams have used this data as a benchmark to compare their program’s complication rate related to IV r-tPA treatment in acute ischemic stroke.
Hypothesis: We examined the percent of acute ischemic stroke patients treated with IV r-tPA each year who developed sICH, and compared our sICH rate with the NINDS benchmark data for this adverse outcome. We anticipated that the sICH rate would decline with additional experience and expanded use of evaluation and treatment protocols at our institution.
Methods: Clinical data was analyzed from consecutive patients (n = 187) receiving IV rt-PA therapy from January 2009 until December 2012 at the Yale-New Haven Hospital. Adverse outcome was assessed by presence of symptomatic intracerebral hemorrhage (sICH). According to the NINDS definition, a hemorrhage was considered symptomatic if it was not seen on a previous CT scan and there had subsequently been either a suspicion of hemorrhage or any decline in neurologic status. The proportion of patients with sICH was calculated for each year and pairwise comparisons were made using two-sample tests of proportions.
Results: 18 out of 187 patients (9.6%) who received IV r-tPA therapy between 2009 and 2012 developed sICH after IV r-tPA treatment. When analyzed by year, 17.74% of sICH cases occurred in 2009, and this proportion decreased to 11.76% in 2010 (p-value = 0.4424), to 8.89% in 2011 (p-value = 0.1952) and to 2.86% in 2012 (p-value = 0.0329).
Conclusions: The proportion of ischemic stroke patients who were treated with IV rt-PA and subsequently developed sICH decreased each year from 2009 to 2012 at our center. This difference reached statistical significance by 2012. Our program’s expanded experience and focused approach using current guidelines and latest published practices likely explain the two-fold reduction in complication rates when compared to the NINDS benchmark. Further studies are warranted to compare our clinical decision-making protocol to proposed models for predicting adverse outcome after IV rt-PA therapy.
Author Disclosures: K.V. Nystrom: None. D.T. Asuzu: None. K.N. Sheth: None. N. Chi: None. J.R. Halliday: None. C. Wira: None. D.M. Greer: None. J.L. Schindler: None.
- © 2014 by American Heart Association, Inc.