Abstract W P174: Risk of Intracranial Hemorrhage after Acute Ischemic Stroke in Patients with Systemic Rheumatologic Conditions: A Nationwide Analysis

Abstract

Introduction: Rheumatologic conditions like Systemic Lupus Erythematosus (SLE), Antiphospholipid antibody (ApL) syndrome, Rheumatoid Arthritis (RA) and scleroderma are known risk factors of CVA. The data on impact of these conditions on risk of intracranial hemorrhage (ICH) in patients of acute ischemic stroke is limited. Methods: We queried the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) data between 2004 and 2010 with ICD 9 diagnostic codes for acute ischemic stroke published by HCUP. Severity of co-morbidities was determined using Deyo modification of Charlson co-morbidity index (CCI). Primary outcome of the study was development of ICH. Multivariate predictors for ICH were identified by logistic regression model. Using SAS 9.2, Survey procedures were used to accommodate for hierarchical two stage cluster design of NIS. Results: A total of 791,015 (weighted N= 3,900,707) patients hospitalized with acute ischemic stroke were available for analysis. After controlling for confounders (thrombolytic therapy, age, sex, atrial fibrillation, chronic kidney disease, diabetes mellitus, rheumatic heart disease, diseases of endocardium, CCI, hospital region, and hospital teaching status ), presence of SLE (OR=0.775, 95% CI=0.575-1.044), and scleroderma (OR=1.060, 95% CI= 0.545-2.063) were not associated with risk of ICH; whereas, presence of ApL syndrome was associated with significantly increased risk of ICH (OR= 1.889, 95% CI=1.672-2.156). In subgroup analysis, patients with ApL syndrome, had higher risk of ICH with thrombolytics (OR=2.464, 95% CI=1.722-3.528), as well as without thrombolytics (OR=1.860, 95%CI= 1.626-2.127). In contrast, patients with RA had lower risk (OR=0.793, 95%CI=0.658-0.955) of ICH; but in patients who received thrombolytics, RA had no impact on risk of ICH (OR=0.716, 95%CI=0.086-5.923). Conclusion: There is increased risk of ICH after ischemic stroke, in patients with ApL Syndrome. The risk of ICH further increases when they receive thrombolytic therapy. The risk of ICH after ischemic stroke is low in RA population; however there is no difference in risk of ICH if they receive thrombolytics. SLE and scleroderma are not associated with ICH in patients of ischemic stroke.