Abstract W P236: Predictors of thrombolysis in Young Adults with Ischemic Stroke

Abstract

Introduction: Approximately 10% to 22.5% of ischemic strokes occur in young adults (18-49 years). We examined factors associated with IV tPA use in young adult stroke (YAS) patients. Methods: Using our institutional GWTG database, we analyzed 5,120 consecutive stroke admissions (01/2004 - 03/2013). Univariate and multivariable models explored factors associated with IV tPA use. Results: YAS comprised 12% of the cohort (n=619). Compared to older adults, YAS patients were more often Hispanic and non-Caucasian, had significantly less vascular risk factors and lower median NIHSS scores. Fifteen percent (n=94) of YAS patients received IV tPA. Atrial fibrillation was present in 3.4% YAS cases (all above age 38). In univariate analysis, factors associated with IV tPA use in the YAS cohort included Caucasian race, atrial fibrillation and higher NIHSS, but only atrial fibrillation and higher NIHSS were independently associated with tPA use in multivariable analysis (Table). Of all YAS patients receiving IV tPA, 2/94 (2.1%) had symptomatic intracranial hemorrhage and another 2/94 (2.1%) had serious systemic hemorrhage within 36hr of IV tPA administration. Conclusion: In the YAS population, those with higher NIHSS scores and atrial fibrillation are more likely to receive IV tPA. These data suggest that more severe strokes and those with a recognized cardioembolic mechanism are more likely to get thrombolysis. Reassuringly, the rate of IV tPA bleeding complications is quite low in YAS patients. Further studies should investigate reasons for non-treatment with thrombolysis and outcomes in YAS patients with less severe presentations.