Abstract
Background and Purpose: Although IV tissue plasminogen activator (tPA) is standard care for acute ischemic strokes (AIS), its administration continues to be a topic of controversy among patients with dementia. This study compared in-hospital outcomes for dementia versus non-dementia patients treated with IV tPA for acute ischemic strokes. Materials and Methods: Using the Nationwide Inpatient Sample (NIS) from 2001-2010, patients with the primary diagnosis of ischemic stroke were identified. We studied outcomes of IV-tPA treatment for acute ischemic stroke in patients with dementia versus a non-dementia control group. Using a 1:2 matched propensity score analysis we controlled for demographic factors, cardiovascular comorbidities and Charlson comorbidity index between groups. Outcomes studied included in-hospital mortality, hospital discharge status and intracranial hemorrhage (ICH). Results: A total of 24,904 patients with acute ischemic strokes who underwent IV tPA therapy for AIS were included in this study. 659 of which had a diagnosis of dementia. After 1:2 matching based off of age, gender, cardiovascular risk factors and Charlson comorbidity index there were a total of 657 patients in the dementia group and 1314 patients in the non-dementia group. Patient outcomes after propensity core analysis showed no difference with in-hospital mortality in the dementia group vs. control (13% vs 14%, p=0.67), discharge to long-term care facilities (63% vs 59%, p=0.08) and ICH (7.9% vs. 9.1%, p=0.86). Conclusions: There was no statistically significant difference in in-hospital mortality, discharge status or ICH rates in patients with AIS and dementia who received IV tPA compared to those without dementia. These results suggest that dementia is not a predictor of poor in-hospital outcome following IV tPA administration for AIS. Further longitudinal studies are needed to determine if IV tPA therapy would improve long-term outcomes for dementia patients with AIS.
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