Abstract Details

Title Low Serum Calcium and Clinical Outcomes Following Systemic Thrombolysis in Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-014

Objective To determine if admission calcium status is associated with stroke outcomes after systemic thrombolysis for acute ischemic stroke (AIS).

Background

Serum calcium (Ca) is essential to the clotting cascade and for thrombus formation. In AIS, Ca status influences infarct volume and the risk of hemorrhagic transformation.

Design/Methods Consecutive patients (Jan 2016 – Dec 2017) who presented with AIS to our Primary Stroke Center and received IV alteplase were retrospectively analyzed. Demographics, medical history, initial lab values, stroke severity (NIHSS), in-hospital course, and discharge disposition were recorded. Patients with Ca < 9 and >= 9 mg/dL were compared. Statistical significance was determined using Chi-square or analysis of variance (ANOVA).

Results We identified 84 patients who met inclusion criteria. Patients with Ca < 9 (n=52) were older (median 78; IQR 42, 92 vs. 75; IQR 20, 96), more were female (57.7 vs. 46.9%), and had greater pre-treatment median NIHSS scores (13; IQR 2, 30 vs. 7; IQR 2, 29). In addition, a greater proportion post-alteplase received endovascular therapy (32.7 vs. 9.4%, p=0.03). Post-alteplase complications occurred in 20 patients overall (23.8%). Of these, hemorrhages requiring transfusions (7.7 vs. 3.1%) and sICH (13.5 vs. 6.3%) were also more frequent in the Ca < 9 group. More patients in the Ca < 9 group were discharged to hospice/palliative care (25 vs. 18.8%) or deceased (28.8 vs. 15.6%).

Conclusions

AIS patients with low admission Ca receiving systemic thrombolysis more frequently required endovascular therapy post-alteplase. This may represent unique thrombosis physiology warranting further investigation. While limited by small numbers, these patients also showed a trend towards worse observed clinical outcomes. Larger prospective studies are needed to investigate these relationships, determine if additional differences exists, and the effects of Ca correction.

Authors/Disclosures
Harn Shiue, PharmD (Mayo Clinic Arizona Hospital) PRESENTER	Dr. Shiue has nothing to disclose.
	No disclosure on file
	No disclosure on file
Kara A. Sands, MD (University of Alabama at Birmingham, Department of Neurology)	Dr. Sands has nothing to disclose.

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Abstract Details