Normal saline vs balanced intravenous fluids in acute ischemic stroke: A retrospective study

Area of Science:

• Neurology
• Critical Care Medicine
• Clinical Pharmacy

Background:

• Optimal intravenous (IV) fluid choice for critically ill patients remains debated, with some evidence favoring balanced solutions over normal saline.
• The ideal IV fluid for acute ischemic stroke patients undergoing thrombolysis is not well-established.
• Hemorrhagic transformation and long-term disability are significant concerns in acute ischemic stroke management.

Purpose of the Study:

• To investigate the association between balanced crystalloid solutions versus normal saline and outcomes in acute ischemic stroke patients.
• To determine if IV fluid choice impacts the risk of hemorrhagic transformation or 90-day disability after thrombolysis.

Main Methods:

• Retrospective chart review of Get with the Guidelines® data (2015-2019) from a single academic medical center.
• Included patients with acute ischemic stroke treated with intravenous tissue plasminogen activator (tPA).
• Multivariate analysis controlled for key demographic, clinical, and treatment variables to assess outcomes (modified Rankin Scale at 90 days, hemorrhagic transformation).

Main Results:

• Exposure to balanced solutions was associated with increased 90-day disability in both univariate (OR 4.3) and multivariate analyses (OR 6.3).
• Balanced solutions were also linked to a higher risk of hemorrhagic transformation in univariate analysis (OR 2.0), but this did not reach statistical significance in multivariate analysis.
• Normal saline administration was not associated with increased risk of adverse outcomes in this cohort.

Conclusions:

• In patients with acute ischemic stroke treated with thrombolysis, balanced IV fluid solutions are associated with an increased risk of 90-day disability.
• A possible association between balanced solutions and hemorrhagic transformation exists, warranting further investigation.
• Normal saline may be a preferred IV fluid choice for acute ischemic stroke patients receiving thrombolysis, pending results from larger prospective trials.