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Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States.
J Stroke Cerebrovasc Dis. 2013 Nov; 22(8):e354-9.JS

Abstract

OBJECTIVE

To determine the outcomes of dialysis-dependent renal failure patients who had ischemic stroke and were treated with intravenous (IV) thrombolytics in the United States.

METHODS

We analyzed the data from Nationwide Inpatient Sample (2002-2009) for all thrombolytic-treated patients presenting with acute ischemic stroke with or without dialysis dependence. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications including secondary intracerebral hemorrhage (ICH), sepsis, pneumonia, pulmonary embolism, deep venous thrombosis, urinary tract infections, and discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the groups.

RESULTS

Of the 82,142 patients with ischemic stroke who receive thrombolytic treatment, 1072 (1.3%) was dialysis dependent. The ICH rates did not differ significantly between patients with ischemic stroke with or without dialysis who received thrombolytics (5.2% versus 6.1%). The in-hospital mortality rate was higher in dialysis-dependent patients treated with thrombolytics (22% versus 11%, P≤.0001). After adjusting for age, sex, and comorbidities, dialysis dependence was associated with higher rates of in-hospital mortality in patients treated with thrombolytics (odds ratio, 1.92; 95% confidence interval, 1.33-2.78, P=.0005).

CONCLUSIONS

The 2-fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis-dependent patients who present with acute ischemic stroke warrant a careful assessment of risk-benefit ratio in this population.

Authors+Show Affiliations

Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota; Department of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: nomitq@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23635922

Citation

Tariq, Nauman, et al. "Outcomes of Thrombolytic Treatment for Acute Ischemic Stroke in Dialysis-dependent Patients in the United States." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 22, no. 8, 2013, pp. e354-9.
Tariq N, Adil MM, Saeed F, et al. Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States. J Stroke Cerebrovasc Dis. 2013;22(8):e354-9.
Tariq, N., Adil, M. M., Saeed, F., Chaudhry, S. A., & Qureshi, A. I. (2013). Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 22(8), e354-9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.016
Tariq N, et al. Outcomes of Thrombolytic Treatment for Acute Ischemic Stroke in Dialysis-dependent Patients in the United States. J Stroke Cerebrovasc Dis. 2013;22(8):e354-9. PubMed PMID: 23635922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States. AU - Tariq,Nauman, AU - Adil,Malik M, AU - Saeed,Fahad, AU - Chaudhry,Saqib A, AU - Qureshi,Adnan I, Y1 - 2013/04/28/ PY - 2013/01/13/received PY - 2013/03/02/revised PY - 2013/03/14/accepted PY - 2013/5/3/entrez PY - 2013/5/3/pubmed PY - 2014/12/17/medline KW - Ischemic stroke KW - dialysis KW - renal failure KW - thrombolysis SP - e354 EP - 9 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 22 IS - 8 N2 - OBJECTIVE: To determine the outcomes of dialysis-dependent renal failure patients who had ischemic stroke and were treated with intravenous (IV) thrombolytics in the United States. METHODS: We analyzed the data from Nationwide Inpatient Sample (2002-2009) for all thrombolytic-treated patients presenting with acute ischemic stroke with or without dialysis dependence. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications including secondary intracerebral hemorrhage (ICH), sepsis, pneumonia, pulmonary embolism, deep venous thrombosis, urinary tract infections, and discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the groups. RESULTS: Of the 82,142 patients with ischemic stroke who receive thrombolytic treatment, 1072 (1.3%) was dialysis dependent. The ICH rates did not differ significantly between patients with ischemic stroke with or without dialysis who received thrombolytics (5.2% versus 6.1%). The in-hospital mortality rate was higher in dialysis-dependent patients treated with thrombolytics (22% versus 11%, P≤.0001). After adjusting for age, sex, and comorbidities, dialysis dependence was associated with higher rates of in-hospital mortality in patients treated with thrombolytics (odds ratio, 1.92; 95% confidence interval, 1.33-2.78, P=.0005). CONCLUSIONS: The 2-fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis-dependent patients who present with acute ischemic stroke warrant a careful assessment of risk-benefit ratio in this population. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/23635922/Outcomes_of_thrombolytic_treatment_for_acute_ischemic_stroke_in_dialysis_dependent_patients_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(13)00085-2 DB - PRIME DP - Unbound Medicine ER -