Abstract WP206: Outcomes of Acute Ischemic Stroke in Patients With Alcohol Abuse: 10 Year National Estimate

Abstract

Background: Excessive alcohol intake is associated with increased risk of stroke. Those with alcohol abuse are also at risk for developing cardiomyopathy, liver disease, anemia and thrombocytopenia. We seek to evaluate the impact of alcohol use on acute ischemic stroke patients using the Nationwide Inpatient Sample. Methods: We derived our study cohort from Nationwide Inpatient Sample (NIS) database (2005-2014) to identify AIS using appropriate ICD-9CM codes in primary diagnosis field, alcohol abuse by variable “cm_alcohol” provided by NIS and Intravascular thrombolysis utilization by procedure code 99.10 in any procedural field. Differences between categorical variables were tested using the chi-square test and continuous variables using the Student t-test. Results: We identified 4332783 patients with acute ischemic stroke (AIS) in our study group, of which 141113 (3.3%) patients were alcohol abusers. Patients with alcohol abuse and AIS were younger (61 vs. 71.5years; p<0.0001) and predominantly male (80.3%). They were more likely to receive thrombolysis (7.2% vs. 5.7%; p<0.0001) and mechanical thrombectomy (1% vs. 0.7%; p<0.0001). Patients with a history of alcohol abuse and AIS who received thrombolysis had a higher co morbidity index and were more likely to be treated at a large or teaching hospital. They also had an increased risk of intracranial bleeding (1% vs. 0.3%; p<0.0001) and major bleeding (10% vs. 3.3%; p<0.0001). Longer median length of stay (5 vs. 4 days; p<0.0001) and higher median cost (17603 vs 9275 dollars; p<0.0001) were also noted. There was increased in-hospital mortality among those alcohol abuse patients who received thrombolysis (6.3% vs. 3.7%; p<0.0001). Conclusion: In conclusion, patients with alcohol abuse and AIS had a thrombolysis rate of 7.2%. After thrombolysis, they were more likely to have intracranial bleeding, major bleeding and in-hospital mortality. We postulate that the increased rate of bleeding complications may be secondary to underlying coagulopathy or decreased liver clearance in those with alcohol abuse.