Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults

E. M. Sweeney, K. T. Thakur, J. L. Lyons, B. R. Smith, J. Z. Willey, A. M. Cervantes-Arslanian, M. K. Hickey, K. Uchino, D. C. Haussen, S. Koch, L. H. Schwamm, M. S.V. Elkind, R. T. Shinohara, F. J. Mateen

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background and purpose: To our knowledge there are no studies reporting the use and short-term outcomes of intravenous tissue plasminogen activator (IV-TPA) for the treatment of acute ischaemic stroke (AIS) in people living with HIV. Methods: The US Nationwide Inpatient Sample (NIS) (2006-2010) was searched for HIV-infected AIS patients treated with IV-TPA. Results: In the NIS, 2.2% (62/2877) of HIV-infected AIS cases were thrombolyzed with IV-TPA (median age 52 years, range 27-78, 32% female, 22% Caucasian) vs. 2.1% (19 335/937 896) of HIV-uninfected cases (median age 72 years, range 17-102 years, 50% female, 74% Caucasian; P = 0.77). There were more deaths in HIV-infected versus uninfected patients with stroke (220/2877, 7.6% vs. 49 089/937 547, 5.2%, P < 0.001) but no difference in the proportion of deaths amongst IV-TPA-treated patients. The age- and sex-adjusted odds ratio for death following IV-TPA administration in HIV-infected versus uninfected patients was 2.26 (95% CI 1.12, 4.58), but the interaction on mortality between HIV and IV-TPA use was not statistically significant, indicating no difference in risk of in-hospital death by HIV serostatus with IV-TPA use. A higher number of HIV-infected patients remained in hospital versus died or were discharged at both 10 and 30 days (P < 0.01 at 10 and 30 days). No difference in the proportion of intracerebral hemorrhage in the two groups was found (P = 0.362). Conclusions: The in-hospital mortality is higher amongst HIV-infected AIS patients than HIV-uninfected patients. However, the risk of death amongst HIV-infected patients treated with IV-TPA is similar to HIV-uninfected groups. European Journal of Neurology

Original languageEnglish (US)
Pages (from-to)1394-1399
Number of pages6
JournalEuropean Journal of Neurology
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2014

Keywords

  • HIV
  • Cerebral infarction
  • Cerebrovascular diseases and cerebral circulation
  • Infections
  • Neurological disorders
  • Stroke
  • Thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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    Sweeney, E. M., Thakur, K. T., Lyons, J. L., Smith, B. R., Willey, J. Z., Cervantes-Arslanian, A. M., Hickey, M. K., Uchino, K., Haussen, D. C., Koch, S., Schwamm, L. H., Elkind, M. S. V., Shinohara, R. T., & Mateen, F. J. (2014). Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. European Journal of Neurology, 21(11), 1394-1399. https://doi.org/10.1111/ene.12506