Thrombolysis for Ischemic Stroke Associated With Infective Endocarditis Results From the Nationwide Inpatient Sample
ABSTRACT Cerebral ischemic events are highly prevalent and associated with high rates of death and disability in patients with infective endocarditis (IE). However, the role of thrombolysis in these patients remains unclear. We sought to determine the rates and outcomes of acute ischemic stroke patients with IE treated with intravenous thrombolysis (IVT).
We determined the rates of post-thrombolytic intracerebral hemorrhage and favorable outcome among acute ischemic stroke patients with IE treated with IVT. Patients were identified using Nationwide Inpatient Sample data from 2002 to 2010. We compared the rates of various outcomes with ischemic stroke patients without IE treated with IVT.
There were 222 patients (mean age 59±18 years; 46% women) who were treated with IVT for acute ischemic stroke associated with IE and 134 048 patients (mean age 69±15 years; 49% women) who were treated for stroke without IE. The rate of post-thrombolytic intracerebral hemorrhage was significantly higher in patients with IE compared with those without IE (20% versus 6.5%; P=0.006). There was a significantly lower rate of favorable outcome in the IE group (10% versus 37%; P=0.01).
High rates of post-thrombolytic intracerebral hemorrhage and low rates of favorable outcome mandate caution in using IVT in acute ischemic stroke patients with IE.
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ABSTRACT: Cerebral infarction and hemorrhage are one of the principal sources of morbidity and mortality associated with mechanical circulatory support. There has been particular concern with the recently reported increased rate of device thrombosis in continuous flow left ventricular assist devices. The neurological management of stroke among these patients has limited data to inform current clinical practices. In this manuscript we review the available literature on stroke in patients with continuous flow left ventricular assist devices, with a focus on treatment algorithms in the acute setting and for secondary stroke prevention.The Journal of Heart and Lung Transplantation 09/2014; 33(9). DOI:10.1016/j.healun.2014.05.005 · 5.61 Impact Factor