Abstract 37: Outcomes Associated With Intraventricular Thrombolysis Among Patients With Intracerebral Hemorrhage: Propensity Score Analysis of 10-Year Contemporary Real-World Data

Abstract

Introduction: Intraventricular thrombolysis (IVT) for hematoma evacuation among eligible intracerebral hemorrhage (ICH) patients is a promising modality to improve outcomes. Methods: We analyzed deidentified pooled data from a network of 40 healthcare organizations (Aug 2010 - Jul 2020). Using ICD-10 diagnosis / procedure, current procedural terminology codes, and medications; we identified index ICH events for extra ventricular drain (EVD) placement with or without IVT. Non adult (< 18 years) patients with thrombolysis use or conditions requiring thrombolysis (cerebral / myocardial infarction, pulmonary embolism, hemodialysis) within 3-days prior to the index event were excluded. IVT and non-IVT patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Match adequacy was assessed by standardized mean difference (SMD). Risk Ratios (RR), 95% Confidence Intervals (CI) were calculated for mortality at 7,30, and 90-days. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed. Results: Among 109,754 patients with an index ICH event 76,608 met the inclusion criteria. Of whom, 7,539 (9.8%) were coded for EVD presence, and 1,688 (22.4%) received IVT. Significant differences in demographic and clinical parameters were observed between IVT and non-IVT groups (graphic). At 90-days 28.4% of non-IVT and 23.2% of IVT ICH patients had died. PS algorithm yielded a 1:1 optimally matched sample (94% SMD reduction) of 1,163 IVT and non-IVT ICH patients each, without significant differences across any co-variates. In the matched sample, the mortality risk was significantly lower for the IVT group at all three timepoints. RR (CI) for 7-day: 0.62(0.50 - 0.77), for 30-day: 0.76(0.65 - 0.88), and for 90-day 0.85(0.74 - 0.97). LRT p < 0.001 for all timepoints, KM curve for 30-day outcome shown in the graphic. Conclusion: Real world utilization of IVT for eligible ICH patients demonstrates significant reduction in early mortality.