Thrombolytic treatment for in-hospital ischemic strokes in United States

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.

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.

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).

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.