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Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone
  1. Ameer E Hassan1,2,3,
  2. Hari Kotta4,
  3. Leeroy Garza2,
  4. Laurie Preston2,5,
  5. Wondwossen Tekle1,2,3,
  6. Amrou Sarraj6,
  7. Adnan I Qureshi7
  1. 1 Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  2. 2 Neuroscience Department, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
  3. 3 Neurology and Radiology, University of Texas Health Science Center, San Antonio, Texas, USA
  4. 4 University of Texas Medical Branch School of Medicine, Galveston, Texas, USA
  5. 5 Clinical Research, Valley Baptist Health System, Harlingen, Texas, USA
  6. 6 Department of Neurology, UT Houston, Houston, Texas, USA
  7. 7 Zeenat Qureshi Stroke Institute, St Cloud, MN, USA
  1. Correspondence to Dr Ameer E Hassan, Department of Neurology, University of Texas Rio Grande Valley. Harlingen, TX 78550; ameerehassan{at}


Objective To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA).

Methods We retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0–2) were collected. Univariate and multivariate statistical analyses were performed.

Results Of a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21).

Conclusion Patients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.

  • thrombolysis
  • thrombectomy
  • stroke
  • intervention
  • hemorrhage

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  • Contributors AEH provided research question, analyzed the data, and revised the paper. HK developed the statistical analyses, drafted the paper, and revised the paper. LG provided the hospital bill data. WT revised the paper. AS revised and edited the paper. AQ revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AEH Consultant for Medtronic, Microvention, Penumbra, Stryker, Genentech and GE Healthcare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.