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Abstract
Background Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) are both effective treatments for patients with large vessel occlusion (LVO) acute ischemic stroke, however, it is unclear whether intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT), also termed bridging thrombolysis, is beneficial for all patients.
Methods This was a large-scale cross-sectional study of the 2016-2020 National Inpatient Sample (NIS) database. Adult EVT patients presenting directly to thrombectomy centers without prior treatment were identified. Patient demographics, stroke risk factors, stroke etiology, medical comorbidities, and IVT treatment were recorded. Primary outcome was in-hospital mortality. Secondary outcomes include rates of discharge to home and hemorrhagic complications. Multivariable logistic regression models were used to account for possible confounders.
Results 35,735 EVT patients were identified, of whom 32.5% (11,630 patients) were treated with IVT. Overall, bridging thrombolysis was significantly associated with lower rates of in-hospital mortality (8.8% vs. 11.2%, p<0.001) and higher rates of discharge to home (38.0% vs. 28.7%, p<0.001). Age stratified analyses revealed that IVT’s association with lower odds of in-hospital mortality was significantly attenuated with increasing age (interaction p=0.038), and that there is no significant association between IVT treatment with in-hospital mortality in elderly patients after multivariable adjustments (80-89 years old, OR 0.99 [95%CI 0.72-1.35], p=0.94). Similarly, older age significantly amplifies the hemorrhagic risk associated with bridging thrombolysis (interaction p=0.006). When considering only patients without hemorrhagic complications, age does not significantly modulate IVT’s association with in-hospital mortality (interaction p=0.61).
Conclusions Bridging thrombolysis may be associated with better outcomes in a real-world setting; however, this association is diminished among elderly patients due to higher rates of hemorrhagic complications. Meta-analyses of trial data and future prospective studies are needed to fully elucidate the benefits and risks of bridging thrombolysis in the elderly population.
Disclosures H. Chen: None. M. Khunte: None. M. Colasurdo: None. A. Malhotra: None. D. Gandhi: 1; C; National Institutes of Health, Focused Ultrasound Foundation, MicroVention, University of Calgary, University of Maryland Medical Center.