Abstract TP5: Prior Intravenous Thrombolytics Administration is Associated With Increased Hospital Bills & Intracranial Hemorrhage Rates Without Improved Outcomes in Mechanical Thrombectomy Patients

Abstract

Background: The efficacy of intravenous thrombolytics (IV TPA) administration in conjunction with endovascular treatment (EVT) has recently come into question. If IV TPA does not offer significant patient outcome benefits nor significantly reduce rates of endovascular complications, its additional cost may present as an unnecessary financial burden. Objective: To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo EVT alone and patients who undergo EVT with IV TPA. Materials and Methods: We retrospectively grouped patients in an EVT database into those who underwent EVT and those who underwent EVT+IV TPA. Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (i.e. negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge NIHSS score, and functional independence data (mRS 0-2) were collected. Univariate and bivariate statistical analyses were performed. Results: Of 254 total patients, 96 (37.8%) underwent EVT+IV TPA. Median NIHSS score at admission was significantly higher in the EVT+IV TPA group than the EVT group (p = 0.006). After adjusting for NIHSS admission score, EVT+IVTPA patient bills and encounter charges were still found to be $3,861.64 (95% CI: $658.84 - $7,064.45, p = 0.02) and $103,946.37 (95% CI: $76,717.21 - $131,174.97, p = 0.001) greater than the EVT only group respectively. The EVT+IV TPA group had a higher complication rate of intracranial hemorrhage (ICH) (p = 0.005). EVT and EVT+IV TPA groups did not significantly differ in median discharge NIHSS score (p = 0.56), in functional independence rate at 90 days (p = 0.96), nor in average hospital stay length (p = 0.21). Conclusion: Patients undergoing EVT + IV TPA are associated with greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo EVT only.