Abstract WP378: RAcial Disparities in Ich After iv-tpA and Neurointerventional Treatment (RADIANT)

Abstract

Introduction: Studies have reported ethnic/racial disparities in intravenous tPA treatment. The outcome of tPA and/or intra-arterial intervention (IA) among different ethnicities/races requires investigation. The purpose of the study was to examine the symptomatic intracranial hemorrhage (SxICH) and major systemic hemorrhage (MSH) after acute stroke treatment among different ethnicities/races. Methods: We retrospectively reviewed all stroke code patients from an IRB- approved stroke code registry between June 2004 and June 2018. We identified patients who received either IV tPA, IA, or IV tPA+IA. Demographics, clinical presentation, co-morbidities, stroke treatments, and adverse outcomes were collected. Patients were classified into two ethnic groups - Hispanics or non-Hispanics (H/NH) and four racial groups- Asians, Black, Others (includes Native Americans and Pacific Islanders), and White (A/B/O/W). Results: We identified 916 patients that received acute therapy (A/B/O/W: n=50/104/16/746, H/NH: n= 184/730). For those received IV tPA only (n=759), the overall SxICH rate was 4.3% (A/B/O/W: 8.1%/6.6%/8.3%/3.7%, p=0.17; H/NH: 5.7%/4.1%, p=0.42), and the MSH rate was 1.3% (A/B/O/W: 2.7%/1.1%/0%/1.3%, p=0.55; H/NH=1.4%/1.3%, p=1.00). White race was significantly correlated with lower SxICH rate after IV tPA (OR 0.07, p=0.02). There was a significant correlation between age and baseline NIHSS with SxICH (p<0.01, p=0.02, respectively). Age, INR and PTT were independent predictors of SxICH after IV tPA (OR 1.06, 46.52 and 1.18, p= 0.02, 0.04 and 0.04, respectively). For IA only (n=85), the rate of SxICH was 4.7% (A/B/O/W: 0%/0%/25%/4.5%, p=0.31; H/NH: 0%/ 6.1%, p=0.57), and 6.9% for IV tPA+IA (A/B/W: 0%/16.7%/6.6%, p=0.59; H/NH: 4.2%/8.3%, p=0.66). There was no MSH in IA only or IV tPA+IA groups. Conclusions: White race correlated with a significantly lower rate of SxICH after IV tPA. There was no significant difference in the rate of SxICH or MSH after IV tPA, IA, or IV tPA+IA among different racial or ethnic groups in this study. Larger studies are needed to elucidate the race specific causes of these SxICH and MSH after acute stroke treatment.