Abstract WP397: Effect of Anti-Hypertensive Medications on Hemorrhagic Transformation in Ischemic Stroke

Abstract

Introduction: Ischemic Stroke is one of the leading causes of mortality and morbidity in the US. Hemorrhagic Transformation (HT) is one the most feared complications of ischemic stroke increasing its mortality and disability, especially in the setting of administration of TPA (tissue plasminogen activator) and intervention with thrombectomy. The objective of this study is to understand the effect of anti-hypertensive medications (AHMs) on hemorrhagic transformation in ischemic stroke patients. Methods: This is a retrospective study in patients who underwent TPA and/or thrombectomy from 2016 to 2017 at a tertiary referral center. . Primary outcome measure was HT at 24 hours in the setting of use of AHMs. Subject stratification was done based on patient’s age, sex, stroke side and location, blood pressure, anti-hypertensive medications (AHMs), admission type (direct emergency room admission versus outside hospital transfer), and lab values on admission. Results: 140 patients were included in this study. Use of AHMs was done in 53 (37.8%) patients. With regards to individual AHMs used, nicardepine was used in 35 (25.00%), labetolol in 50 (35.71%), hydralazine in 15 (10.7%), esmolol in 19 (13.57%) and others in 3 (2.14%) of these patients. Logistic regression model including only admission type and use of any antihypertensive medication as predicting variables was performed, and the use of any anti-hypertensive medications was statistically significant in predicting the odds of HT. Subjects in whom no AHMs were used were found to have 121% higher odds for HT relative to those who were given any AHMs(OR=2.210, 95% C.I. 1.031-4.740, p=0.0416). Individual AHMs nicardepine, labetolol, hydralazine, esmolol or others and admission type did not differ significantly in predicting the odds of HT. Conclusion: Our study shows the use of AHMs to be associated with decreased risk of hemorrhagic transformation in patients who received TPA, thrombectomy or both. There was no statistical significance in relation to specific antihypertensive medications used with regards to hemorrhagic transformation.