Abstract WP122: Refusal of Intravenous Thrombolysis for Acute Ischemic Stroke in San Diego

Abstract

Purpose: To assess the demographic and clinical characteristics of patients who refuse intravenous thrombolysis (IV tPA) for acute ischemic stroke from the Stroke Registry population collected by the University of California San Diego (UCSD) Stroke Team and to compare outcomes between those who were treated with IV tPA and those who refused. Methods: We evaluated patients between July 2004 and July 2019 from the prospective Institutional Review Board (IRB) approved Stroke Registry project. Patients who either received IV tPA or refused IV tPA were included. Baseline demographics, NIHSS, treatment times and 90 day mRS were collected. Results: A total of 1056 patients were included in the analysis. Forty-seven patients (4.5%) refused IV tPA. There were no differences in demographics between patients who were treated with IV tPA and those who refused. Patients who refused IV tPA had a significantly lower baseline NIHSS (4 vs 9, p=<0.0001) and higher baseline mRS (1.3 vs 0.6, p=0.00043) compared to patients who received IV tPA. The time from arrival to treatment decision was significantly longer in patients who refused IV tPA (group mean 57.9 min vs 48.8 min, p=0.03). There was no difference in 90 day mRS between groups. Conclusions: There is a low rate of IV tPA refusal in our registry population which is similar to what previous studies have shown 1,2 . We found that patients who refuse IV tPA have milder deficits and worse pre-morbid disability. We suspect that the longer “arrival to treatment decision” time in the refuse IV tPA group is due to longer informed consent discussions. This study demonstrates the utility of informed consent in clinical practice and highlights the importance of respecting patient autonomy.