Intravenous Thrombolysis Improves Odds of Home Discharge in Ischemic Stroke

Likelihood of home discharge in cervical artery dissection–related acute ischemic stroke (CeAD-AIS) is improved with intravenous thrombolysis (IVT) without increasing risk for intracerebral hemorrhage or inpatient death, according to study findings published in the Journal of the American Heart Association.

CeAD accounts for 10% to 20% of all strokes among young adults globally. Efficacy of IVT in CeAD-AIS is controversial. Therefore, investigators compared outcomes in CeAD-AIS treated with IVT vs without IVT. Home discharge was the primary outcome. Intracerebral hemorrhage and inpatient mortality were among the safety outcomes.

This retrospective study was conducted using ICD-10 codes and data from the National Inpatient Sample to identify adult patients hospitalized from 2016 to 2019 with concurrent CeAD and AIS diagnoses. Patients with aortic dissection or head and neck trauma were among those excluded as were those with missing National Institutes of Health Stroke Scale scores (NIHSS) data.

Across the study period, 12.1% (n=1360 patients; median age, 56.5 years; 73.2% White, 11.1% Black; 6.5% Hispanic; 32.0% women) of 11,285 patients with CeAD-AIS received IVT. Patients treated with IVT vs those without IVT had higher median NIHSS scores (median, 8 [IQR, 4–17] vs 3 [IQR, 1–11]; P <0.001) and were more likely to have received endovascular therapy and cervical artery stenting. IVT was less likely to be associated with diabetes or female gender.

IVT was associated with greater odds of home discharge (adjusted odds ratio [aOR], 1.40; 95% CI, 1.01-1.92; P =.042), and the odds of intracerebral hemorrhage (aOR, 0.69; 95% CI, 0.32-1.48; P =.341) and inpatient mortality (aOR, 1.29; 95% CI, 0.76-2.20; P =.347) were unaffected.

IVT’s effect on home discharge was significantly modified by carotid artery involvement (P_{for interaction}=.021) and stroke severity (P_{for interaction}=.001); IVT was associated with increased likelihood of home discharge in patients with carotid artery involvement and moderate to severe stroke (NIHSS score >4).

Significant study limitations include the retrospective design, underpowered sample size in the atrial fibrillation subgroup, and possible selection bias. Additionally, there may be misclassification bias because of the use of electronic medical records, and ICD-10 codes lack granularity to differentiate between extracranial and intracranial dissections.

“IVT improves the likelihood of home discharge in patients with CeAD-AIS without increasing the risk of inpatient death or intracerebral hemorrhage,” the investigators concluded. “In CeAD, damage to the vessel wall can trigger the formation of thrombi through platelet aggregation and activation of the clotting cascade, which may lead to distal embolization and ischemic events. IVT likely promotes early recanalization by breaking down these clots, thereby improving outcomes in patients with CeAD-related ischemic stroke.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor