Abstract TP315: Predictors of Thrombolysis Administration in Patients with Minor Stroke or TIA in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study
Background: Minor stroke/TIA is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable amongst different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD Study.
Methods: 73,712 patients with ischemic stroke/TIA were prospectively enrolled from January 2010 to April 2015. We included 7,746 patients who had persistent neurological symptoms with NIHSS score ≤5 and arrived within 4 hours of symptom onset. Multilevel logistic regression analysis was used to identify independent predictors of thrombolysis in the subgroup of patients without contraindications to thrombolysis
Results: 6,826 patients (25% final diagnosis TIA, 75% minor stroke) were included (mean age=70±14 years), 52.7% male, 70.3% white, 13% black, 16.7% Hispanic, median NIHSS=2 (IQR=1,4). Patients who received thrombolysis (N=1281, 18.7%) were younger (67 vs. 70.7 years, P<0.001), had less vascular risk factors (HTN, DM, dyslipidemia), lower risk of prior vascular disease (MI, PVD, previous stroke) and had a higher presenting median NIHSS score (4 vs. 2, P<0.0001). In the multivariable analysis, younger age (OR 1.02, 95% CI 1.02-1.03, P<0.0001), white or Hispanic vs. black (OR 1.2, 95% CI 1.04-1.37, P=0.0097), early hospital arrival (unit change in 30 min.) (OR 1.26, 95% CI 1.21-1.31, P<0.0001), arrival by EMS (OR 1.28, 95% CI 1.08-1.49, P<0.0001), higher NIHSS score (OR 1.96, 95% CI 1.87-2.06, P<0.0001), altered level of consciousness (OR 1.43, 95% CI 1.11-1.85, P=0.0062) and aphasia at presentation (OR 1.34, 95% CI 1.13-1.58, P=0.0008) were independent predictors of thrombolysis administration.
Conclusion: Minor acutely presenting stroke patients were more likely to receive thrombolysis if they were young, white or Hispanic, and arrived early to the hospital with more severe neurological presentation specifically aphasia and altered level of consciousness. Identification of predictors of thrombolysis utilization is important in the design of educational programs and randomized trials to increase the use of thrombolysis for minor stroke.
Author Disclosures: N. Asdaghi: None. J.G. Romano: Research Grant; Modest; Research salary support to Department of Neurology at the University of Miami from Genentech (for role as PI of the Mild and Rapidly Improving Stroke Study (MaRISS),, Co-I of the FL-PR CReSD (SPIRP) (U54 NS-081763). Consultant/Advisory Board; Modest; Genentech (for Steering Committee role of the Potential for rtPA to Improve Stroke with Mild Symptoms (PRISMS) Study), Vycor/NovaVision (for Scientific Advisory Board role). K. Wang: None. S. Koch: Research Grant; Modest; Core B Co-I of the FL-PR CReSD (SPIRP) (U54 NS-081763). M.A. Ciliberti-Vargas: None. C. Dong: Research Grant; Modest; Co-I of the FL-PR CReSD (SPIRP) (U54 NS-081763). H. Gardener: None. D.Z. Rose: Speakers' Bureau; Modest; Boehringer Ingelheim Pharmaceuticals, Inc. (PRADAXA®, dabigatran etexilate), 2013-current, Chiesi-USA (prior Cornerstone Therapeutics) (CARDENE IV ®, Nicardipine), 2013-current. W.S. Burgin: Research Grant; Modest; Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-II: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage. Cl, A Phase 3, Randomized, Placebo-Controlled, Double-Blind Study of the Combined Lysis of Thrombus with Ultrasound and Systemic Tissue Plasminogen Activator (tPA) for Emergent Revascularization (CLOTBUST, A Randomised, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin (ASA) in Patients with Acute Ischaemic Stroke or TIA [SOCRATES –Acute Stroke Or Tra. S.P. Waddy: Employment; Significant; This work was sponsored by the National Institutes of Health (NIH), and I am the Project Scientist representing the NIH. M. Robichaux: None. C.M. Gutierrez: None. M.F. Waters: None. R.L. Sacco: Research Grant; Modest; PI of the FL-PR CReSD (SPIRP) (U54 NS-081763). Consultant/Advisory Board; Modest; Boehringer Ingelheim consultant for secondary stroke prevention trial with Dabigatran. T. Rundek: Research Grant; Modest; Core C PI of the FL-PR CReSD (SPIRP) (U54 NS-081763).
- © 2016 by American Heart Association, Inc.