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Thrombolysis for ischemic stroke associated with infective endocarditis: results from the nationwide inpatient sample

Ganesh Asaithambi1, Malik M Adil, Adnan I Qureshi

  • 1From the Zeenat Qureshi Stroke Research Center (G.A., M.M.A., A.I.Q.), University of Minnesota, Minneapolis, MN.

Stroke
|August 15, 2013
PubMed

Insights

Intravenous thrombolysis (IVT) for acute ischemic stroke in infective endocarditis (IE) patients led to higher rates of brain hemorrhage and worse outcomes. Caution is advised when using IVT in this high-risk population.

Area of Science:

  • Neurology
  • Cardiology
  • Critical Care Medicine

Background:

  • Cerebral ischemic events are common in infective endocarditis (IE), leading to significant mortality and disability.
  • The efficacy and safety of thrombolysis in IE patients with acute ischemic stroke are not well-established.

Purpose of the Study:

  • To investigate the incidence of post-thrombolytic intracerebral hemorrhage.
  • To evaluate the outcomes of acute ischemic stroke patients with IE who received intravenous thrombolysis (IVT).

Main Methods:

  • Retrospective analysis of Nationwide Inpatient Sample data from 2002 to 2010.
  • Comparison of outcomes between acute ischemic stroke patients with IE treated with IVT and those without IE treated with IVT.

Main Results:

  • 222 IE patients and 134,048 non-IE patients received IVT for acute ischemic stroke.
  • The rate of post-thrombolytic intracerebral hemorrhage was significantly higher in IE patients (20%) compared to non-IE patients (6.5%; P=0.006).
  • Favorable outcomes were significantly lower in the IE group (10%) versus the non-IE group (37%; P=0.01).

Conclusions:

  • The use of IVT in acute ischemic stroke patients with IE is associated with a substantially increased risk of intracerebral hemorrhage.
  • Favorable outcomes are significantly reduced in IE patients undergoing IVT for stroke.
  • These findings necessitate a cautious approach when considering IVT for acute ischemic stroke in the context of infective endocarditis.
Abstract

Keywords:
endocarditisoutcomes assessmentstrokethrombolytic therapy

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