Abstract
Background and purpose: Recent studies have shown a trend for increasing use of thrombolysis among acute ischemic stroke (AIS) patients. However, data is lacking for use of thrombolysis among young (19-44 years) AIS patients. It is important to follow the trend as costs and burden of stroke related disability can be significantly higher in young adults as they are more likely to live longer than elderly people with stroke. Method: Discharge data were obtained from Nationwide Inpatient Sample from 2001 to 2009. AIS were defined by discharge diagnosis codes from International Classification of Diseases ICD 9 revision (433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436). For thrombolysis treatment ICD 9 code 99.10 was used. For mechanical thrombectomy, code 39.74 was used for year 2006 to 2009. Cochran Armitage test was used for trend analysis. Result: From 2001 through 2009, there were an estimated 4,917,217 admissions for acute ischemic stroke. Out of that, 204,703 (4.16%) were young patients with AIS. Numbers of AIS among young adults increased from 19293(3.30% of total AIS) in 2001 to 24816 (4.57%) in 2009 (p<0.0001). 51.4% patients were female in 2001 and 49.3% in 2009. Thrombolysis in young ischemic stroke increased from 354 (1.84% of young AIS) in 2001 to 1237 (4.97%) in 2009 (p<0.0001). Thrombolysis among all AIS increased from 1.00% to 3.84% (p<0.0001) in the same time period. Number of mechanical thrombectomy increased from 53 (0.14%) in 2006 to 527 (0.82%) in 2009 (p<0.0001) in young AIS. In the same time period, mechanical thrombectomy rate in all AIS patients increased from 0.05% to 0.48% (p<0.0001). Conclusion: Thrombolysis rate among young AIS significantly increased from 2001 to 2009. Thrombolysis rate was higher in young AIS than all AIS for all the years from 2001 to 2009. Mechanical thrombectomy rate also significantly increased from 2006 to 2009 among young AIS and it was almost twice the rate all AIS patients. Data on outcomes of young AIS treated with thrombolysis or mechanical thrombectomy are needed.
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