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Abstract Details

Higher Intracerebral Hemorrhage Rates and Poor Outcome from tPA treatment among Nursing Home Patients
Cerebrovascular Disease and Interventional Neurology
P8 - Poster Session 8 (8:00 AM-9:00 AM)
4-003
To evaluate intracerebral hemorrhage (ICH) from intravenous (IV) tissue plasminogen activator (tPA) at our comprehensive stroke center.
IV tPA, the standard of care for acute ischemic stroke, carries a risk of ICH. Reported clinical trials focus on symptomatic ICH (sICH). Characteristics of patient treated with tPA in our center were different from those included in these trials. Little is known about prevalence and risks of ICH in these patients. 
Retrospective chart review of IV tPA cases (excluding mechanical thrombectomy) from January 2016 to June 2019. ICH was defined by plain head CT 24 hours after tPA and met criteria for Hemorrhagic Infarction 2 (HI2) or Parenchymal Hemorrhage (PH) per ECASS II criteria. Demography, NIHSS and discharge disposition were obtained. T-test was used for statistical analyses. 

Of the 237 patients that received tPA, twelve (5.1%) experienced ICH, five (2.1%) were symptomatic. Six were male. Median NIHSS in ICH was higher than all tPA (16 vs 11, p=0.047). Median age in ICH patients was 80 years compared to 67 years in all that received tPA (p=0.205). Of the ICH patients, nine (75%) received tPA within 3hrs of stroke onset; five (55.6%) were from nursing home and diagnosed dementia. Brain MRI of these five patients showed amyloid angiopathy. Fifty-four tPA patients older than 80 years experienced an ICH rate (11.1%) twice as high compared to all tPA patients, although sICH rate was only 3.7%. Of the ICH patients, six (50%) died and only two (16.7%) were discharged home. Four (90%) of the five nursing home patients died.

Our study shows that actual ICH rate was higher than sICH rate possibly due to higher baseline NIHSS. Elderly patients were associated with higher ICH rate. Poor outcomes were especially seen in nursing home residents and patients with history of dementia. 
Authors/Disclosures
Shivani Naik, MD (Cedar Sinai Medical Center)
PRESENTER 		Dr. Naik has nothing to disclose.
Saurav Das, MD (Washington University in St. Louis) Dr. Das has nothing to disclose.
Riwaj Bhagat, MD (Conemaugh Memorial Medical Center) Dr. Bhagat has nothing to disclose.
No disclosure on file
No disclosure on file
Tracy Ander, DO (na) No disclosure on file
Michael Haboubi, DO (University of Louisville SOM) Dr. Haboubi has nothing to disclose.
Jignesh J. Shah, MD No disclosure on file
Kerri S. Remmel, MD, PhD (Regional Brain Institute) Dr. Remmel has nothing to disclose.
Wei Liu, MD Dr. Liu has nothing to disclose.