Thrombolytic treatment for in-hospital ischemic strokes in United States

Abstract

Background—Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital
acute ischemic stroke, there is little data on outcomes of patients receiving thrombolytics for in-hospital
ischemic strokes. The objective of this study was to determine the rates of patients with in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated on admission.
Methods—We analyzed an 8-year data (2002-2010) from the National Inpatient Survey. We identified
patients who had in-hospital ischemic strokes (thrombolytic treatment after 1 day of hospitalization) and
those treated on admission day. We compared demographics, clinical characteristics, in hospital complications and procedures, length of stay, hospitalization charges, and discharge disposition between the two
groups.
Results—A total of 25193 (19%) and 109784 (81%) patients received thrombolytics for in-hospital and
on admission acute strokes, respectively. In-hospital complications including intracerebral hemorrhage,
pneumonia, deep venous thrombosis, pulmonary embolism and sepsis and in-hospital procedures such as
cerebral angiography, endovascular thrombectomy, carotid artery stent placement, carotid endarterectomy,
intubation, mechanical ventilation, gastrostomy, transfusion of blood products were significantly higher in
the in-hospital stroke group. In a multivariate analysis, those who were treated following in-hospital stroke
had higher rates of in-hospital mortality (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0–1.3, p =
0.05), and post-thrombolytic ICH (OR 1.2, CI 1.0–1.3, p = 0.03).
Conclusion—One out of every five acute ischemic stroke patients treated with thrombolytics is receiving
the treatment for in-hospital stroke. The higher mortality and complicated hospitalization in such patients
needs to be recognized.