Abstract 258: Comorbidities Associated with Exclusion from rtPA in Obese Ischemic Stroke Patients with History of Smoking

Abstract

Introduction Recombinant tissue plasminogen activator (rtPA) is the only approved treatment for acute ischemic stroke (AIS) patients, however, only a minuscule percentage of patients receive rtPA [1, 2]. In some cases, the reason for patients' exclusion from rtPA is due to risk factors and comorbidities [1, 2]. Research has been conducted previously on rtPA exclusion in obese AIS patients as well as AIS patients with a history of smoking [3, 4, 5, 6]. However, little is known regarding the comorbidities associated with exclusion from rtPA in obese AIS patients with a history of smoking. ​ Therefore, a discussion surrounding these patients is warranted in order to better identify AIS patients who require special management in order to be eligible for rtPA. We hypothesize that the comorbidities associated with rtPA exclusion in obese AIS patients with a history of smoking will differ from comorbidities associated with rtPA exclusion in obese AIS patients or AIS patients with a history of smoking. Methods Retrospective data on demographic and clinical risk factors of obese AIS patients with a history of smoking was collected from a large stroke center from January 2010 to December 2016. Univariate analysis was used to differentiate between risk factors and demographics associated with exclusion and inclusion from rtPA. Variables in the univariate analysis were further analyzed using logistic regression. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical risk factor were used to predict the increasing odds of an association of a specific clinical baseline risk factor with exclusion or inclusion from rtPA. Results In the adjusted analysis, Obese AIS patients with a history of smoking excluded from rtPA were more likely to present with CAS (OR = 0.069, 95% CI, 0.011‐0.442), diabetes (OR = 0.604, 95% CI, 0.366‐0.997), higher total cholesterol (OR = 0.975, 95% CI, 0.956‐0.995), history of drug and alcohol use (OR = 0.438, 95% CI, 0.232‐0.828). Higher NIHSS score (OR = 1.051, 95% CI, 1.017‐1.086), ambulation improvement (OR = 2.230, 95% CI, 1.423‐3.496), higher triglycerides (OR = 1.004, 95% CI, 1.001‐1.006), and higher HDL (OR = 1.028, 95% CI, 1.000‐1.057) were associated with Obese AIS patients that received rtPA. Conclusion Our findings reveal specific risk factors or comorbidities that contribute to the exclusion of Obese AIS patients with a history of smoking from rtPA. Specifically, a history of diabetes and higher total cholesterol were associated with rtPA exclusion in obese AIS patients with a history of smoking. These associations were not significantly correlated with rtPA exclusion in the populations of obese AIS patients or AIS patients with a history of smoking. These findings suggest the need to develop management strategies to improve the use of rtPA in obese AIS patients with a history of smoking.