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, Sebastian Koch, L. H. Schwamm, M. S V Elkind, R. T. Shinohara, F. J. Mateen

Research output: Contribution to journalArticle

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

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Tissue Plasminogen Activator
Stroke
HIV
Inpatients
Cerebral Hemorrhage
Neurology
Hospital Mortality
Odds Ratio

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Sweeney, E. M., Thakur, K. T., Lyons, J. L., Smith, B. R., Willey, J. Z., Cervantes-Arslanian, A. M., ... 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

Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. / 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, Sebastian; Schwamm, L. H.; Elkind, M. S V; Shinohara, R. T.; Mateen, F. J.

In: European Journal of Neurology, Vol. 21, No. 11, 01.01.2014, p. 1394-1399.

Research output: Contribution to journalArticle

Sweeney, EM, Thakur, KT, Lyons, JL, Smith, BR, Willey, JZ, Cervantes-Arslanian, AM, Hickey, MK, Uchino, K, Haussen, DC, Koch, S, Schwamm, LH, Elkind, MSV, Shinohara, RT & Mateen, FJ 2014, 'Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults', European Journal of Neurology, vol. 21, no. 11, pp. 1394-1399. https://doi.org/10.1111/ene.12506
Sweeney EM, Thakur KT, Lyons JL, Smith BR, Willey JZ, Cervantes-Arslanian AM et al. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. European Journal of Neurology. 2014 Jan 1;21(11):1394-1399. https://doi.org/10.1111/ene.12506
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, Sebastian ; Schwamm, L. H. ; Elkind, M. S V ; Shinohara, R. T. ; Mateen, F. J. / Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. In: European Journal of Neurology. 2014 ; Vol. 21, No. 11. pp. 1394-1399.
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AU - Smith, B. R.

AU - Willey, J. Z.

AU - Cervantes-Arslanian, A. M.

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AU - Uchino, K.

AU - Haussen, D. C.

AU - Koch, Sebastian

AU - Schwamm, L. H.

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N2 - 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

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