Abstract W P321: Stroke Outcomes and Usage of IV Alteplase During Pregnancy in the Nationwide Inpatient Sample 2005-2010
Background: Although alarmingly increasing trends of stroke in pregnancy has been reported in the US, few studies have investigated clinical outcomes, including outcomes of IV alteplase (tPA) treatment among pregnant women.
Methods: Data was abstracted from the Nationwide Inpatient Sample, an all-payer inpatient care database. We identified pregnancy-related hospitalizations from 2005-2010 by ICD-9-CM diagnostic codes. We extracted diagnoses of acute ischemic stroke (AIS), intracerebral (ICH) and subarachnoid (SAH) hemorrhage, transient ischemic attack, cerebral venous thrombosis (CVT), unspecified, and other pregnancy-related complications. We also identified pregnant women with AIS who received IV tPA. Clinical outcomes included length of stay (LOS), discharge disposition, and in-hospital mortality.
Results: An estimated 18,392 pregnant women were diagnosed with stroke from 2005-2010. CVT (26.8%) and hemorrhagic (ICH and SAH) stroke (22.8%) were the most common types of stroke, with about 20% of all stroke reported as unspecified in 2010. Mean LOS ranged from 6.5-7.2 days; linear regression did not reveal significant trends in LOS over time. The most common pregnancy-related stroke risk factors included hypertension (30.2%) and pre-eclampsia (13.4%). Decreasing trend of discharge home (from 78.3 to 72.6%, p=0.09) and increasing mortality rate (from 1.8% to 4.0% p for linear trend=0.02) were observed from 2005 to 2010. Of the estimated 70 pregnant AIS patients treated with IV tPA, LOS ranged 4-28 days; 78.6% were discharged home, 14.3% to skilled nursing facility, and 7.1% died.
Conclusions: Stroke remains a serious complication in pregnancy, and mortality is increasing. Usage of tPA for AIS during pregnancy is minimal, with increased mortality compared to all strokes in pregnancy. Research efforts are needed to improve stroke outcomes during pregnancy.
Author Disclosures: S. Song: None. B. Ouyang: None. T. Knopf: None. J. Conners: None. S. Cutting: None. V. Lee: None. L. Smit: None. E. Kuklina: None.
- © 2014 by American Heart Association, Inc.