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Abstract Details

Safety and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with History of Intracranial Hemorrhage within the Florida Stroke Registry
Cerebrovascular Disease and Interventional Neurology
S10 - Vascular Interventions and Innovative Technologies (11:15 AM-11:27 AM)
001

IVT is the standard of care for ischemic stroke patients presenting within 4.5 hours of symptom onset, but prior ICH/SAH is a contraindication to its administration due to the theoretical increased risk of hemorrhagic transformation. Small retrospective studies regarding its off-label use have suggested IVT may be safe in this population, necessitating further study.

We evaluated the outcomes of patients receiving intravenous thrombolysis (IVT) with a history of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) to determine the safety of IVT in this population.

Data were prospectively collected from Florida hospitals participating in Get With the Guidelines-Stroke between January 2019 and December 2022. Patients diagnosed with ischemic stroke and treated with IVT were separated into those with a history of ICH/SAH and those without this history.

Among 20,369 patients treated with IVT for acute ischemic stroke, 94 (0.5%) had prior ICH/SAH. Patients with history of ICH/SAH were older (75 vs 70) and more likely to have dyslipidemia (56.4% vs 45.8%), atrial fibrillation (30.9% vs 15.0%), prior ischemic stroke (25.5% vs 11.7%), and antiplatelet drug use (52.1% vs 37.2%), all p values <0.05. Patients with prior ICH/SAH were more likely to develop symptomatic ICH within 36h of IVT (7.5% vs 2.2%, OR 3.6 [1.6-7.8]), while in-hospital mortality was similar (4.3% vs 3.3%). Patients with prior ICH/SAH were less likely to be discharged to home or acute rehab (55.3% vs 70.9%, OR 0.5 [0.3-0.8]) or ambulate independently at discharge (34.0% vs 49.1%, OR 0.5 [0.3-0.8]).

Patients with prior ICH/SAH who received IVT had more than triple the risk of symptomatic hemorrhage compared to those without this history. Our finding underscores apprehensions regarding the safety of IVT in this specific patient population and emphasizes the need for further research and cautious clinical consideration when weighing the risks and benefits of this treatment

Authors/Disclosures
Aaron Shoskes (University of Utah)
PRESENTER
An immediate family member of Dr. Shoskes has received personal compensation for serving as an employee of PepGen.
No disclosure on file
No disclosure on file
Hannah Gardener (University of Miami) Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
Ayham Alkachroum The institution of Ayham Alkachroum has received research support from NIH.
No disclosure on file
Gillian Gordon-Perue (University of Miami) Dr. Gordon-Perue has nothing to disclose.
No disclosure on file
Sebastian Koch (University of Miami) Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Erika Marulanda-Londono (University of Miami) Dr. Marulanda-Londono has nothing to disclose.
No disclosure on file
Tatjana Rundek The institution of Dr. Rundek has received research support from NIH.
Jose Romano (University of Miami, Miller School of Medicine) Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vycor. Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NIMHHD.
Jennifer Majersik (University of Utah) Dr. Majersik has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Woolsey. Dr. Majersik has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Majersik has received research support from NIH/NINDS. The institution of Dr. Majersik has received research support from NIH/NCATS.
Veronica Moreno Gomez (Department of Neurology) Dr. Moreno Gomez has nothing to disclose.
Negar Asdaghi (University of Miami) Dr. Asdaghi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.