Abstract TP399: Complications from IV Alteplase in Mild Stroke Patients in a Multi-state Health System

Abstract

Introduction: The rate of complications from IV alteplase (tPA) for acute ischemic stroke is necessary for discussing risk and benefit when deciding whether to treat. Symptomatic intracerebral hemorrhage (sICH) rate is often quoted as 6.4% based on the NINDS trials. This risk often makes patients and physicians wary of tPA treatment for mild ischemic stroke (MIS). However, NINDS excluded these patients, so risk in MIS is not clear. The Objective of this study was to examine rates of tPA-related complications in MIS compared to moderate-to-severe stroke using real-world data. Methods: Data from a multi-state hospital system included tPA-treated patients discharged between January 2011 and May 2018. Patients who were <18 years old, received thrombectomy, transferred to another hospital, or had inpatient stroke were excluded. Outcomes included percentage of patients who experienced any complication, sICH, life-threatening systemic hemorrhage, other serious complication, or in-hospital mortality or discharge to hospice. Chi-squared and Fisher’s exact tests and generalized linear models were used to compare outcomes between patients with mild (NIHSS ≤ 5) and moderate-to-severe (NIHSS >5) strokes. Results: A total of 3,067 patients met inclusion criteria with 36% (1,111) having a mild stroke. When compared to MIS patients, moderate-to-severe stroke patients were more likely to have sICH (4.4% vs. 1.3%; p<.001), life-threatening systemic hemorrhage (0.8% vs. 0%; p<.001), and other serious complication (2.1% vs. 0.5%; p<.001). In multivariate analysis, patients with moderate-to-severe stroke were 3.69 (95% CI: 2.26, 6.01) times more likely to have any complication and 7.66 (95% CI: 4.82, 12.16) times more likely to die or be discharged to hospice after adjusting for age, sex, hospital, and history of atrial fibrillation, hypertension, diabetes, and coronary artery disease or prior myocardial infarction. Conclusion: Patients with mild strokes that received IV-alteplase had fewer treatment-related complications and were less likely to experience in-hospital mortality or discharge to hospice compared to those with moderate-to-severe strokes. This may inform decision-making in treatment of mild ischemic strokes.