Abstract WMP106: Acute Ischemic Stroke Treatments And Outcomes In Patients With Hematological Malignancies

Abstract

Background: There is limited evidence to guide treatment decisions in patients with acute ischemic stroke (AIS) who have concurrent hematological malignancies. In this study, we aimed to evaluate the impact of acute stroke interventions and clinical outcomes in this patient population. Methods: Hospitalizations with primary diagnosis of AIS were identified from the Nationwide Readmissions Database 2016-2018. Hospital records with age<18 or with concomitant diagnosis of solid organ malignancy were excluded. Logistic regression was used to compare the differences in acute stroke interventions and clinical outcomes in patients with and without hematological malignancies. Survival analysis was used to evaluate recurrent AIS after discharge. Results: There were 1347150 hospitalizations due to AIS (mean±SD age 70.3±14.1 years, female 50.2%). Of these, 11863 (0.9%) had a concurrent diagnosis of hematological malignancy. Patients with malignancy were older and were less likely to have comorbid cerebrovascular risk factors, except atrial fibrillation. Patients with malignancy were less likely to receive intravenous thrombolysis (tPA) but the rates of endovascular thrombectomy (ET) did not differ between the two groups. After adjustment for baseline differences, patients with malignancy had higher in-hospital mortality [odds ratio (OR): 1.2, 95% confidence interval (CI): 1.0-1.3] but other outcomes like intracranial hemorrhage and discharge disposition were comparable between the two groups. Sub-group analysis according to the type of malignancy (leukemia, lymphoma, plasma cell neoplasms, histiocytic/other) showed that only patients with leukemias had higher mortality and adverse discharge disposition. Among the subgroups of patients treated with tPA or ET, the clinical outcomes were comparable between patients with and without malignancy. Further, the overall risk of readmission due to recurrent ischemic stroke was also similar between patients with and without malignancy (hazards ratio: 1.0, 95% CI: 0.9-1.1). Conclusion: Acute reperfusion in ischemic stroke is safe in patients with hematological malignancies. While patients with malignancy have higher in-hospital mortality, they are not at an increased risk of stroke recurrence.