Predictors of Thrombolysis Administration in Mild Stroke

Florida-Puerto Rico Collaboration to Reduce Stroke Disparities

FL-PR CReSD Investigators and Collaborators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

METHODS: Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis.

RESULTS: We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration.

BACKGROUND AND PURPOSE: Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).

CONCLUSIONS: Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalStroke
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2018

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Puerto Rico
Stroke
National Institutes of Health (U.S.)
Odds Ratio
Confidence Intervals
Hispanic Americans
Peripheral Vascular Diseases
Aphasia
Dyslipidemias
Vascular Diseases
Registries
Diabetes Mellitus

Keywords

  • Florida
  • Puerto Rico
  • risk factors
  • stroke
  • therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Predictors of Thrombolysis Administration in Mild Stroke : Florida-Puerto Rico Collaboration to Reduce Stroke Disparities. / FL-PR CReSD Investigators and Collaborators.

In: Stroke, Vol. 49, No. 3, 01.03.2018, p. 638-645.

Research output: Contribution to journalArticle

FL-PR CReSD Investigators and Collaborators. / Predictors of Thrombolysis Administration in Mild Stroke : Florida-Puerto Rico Collaboration to Reduce Stroke Disparities. In: Stroke. 2018 ; Vol. 49, No. 3. pp. 638-645.
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title = "Predictors of Thrombolysis Administration in Mild Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities",
abstract = "METHODS: Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis.RESULTS: We included 6826 cases (final diagnosis mild stroke, 74.6{\%} and TIA, 25.4{\%}). Median age was 72 (interquartile range, 21); 52.7{\%} men, 70.3{\%} white, 12.9{\%} black, 16.8{\%} Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7{\%}) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95{\%} confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95{\%} CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95{\%} CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95{\%} CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95{\%} CI, 1.39-2.95) were independent predictors of thrombolysis administration.BACKGROUND AND PURPOSE: Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).CONCLUSIONS: Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.",
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author = "{FL-PR CReSD Investigators and Collaborators} and Negar Asdaghi and Kefeng Wang and Ciliberti-Vargas, {Maria A.} and Gutierrez, {Carolina Marinovic} and Sebastian Koch and Hannah Gardener and Chuanhui Dong and Rose, {David Z.} and Garcia, {Enid J.} and Burgin, {W. Scott} and Zevallos, {Juan Carlos} and Tatjana Rundek and Sacco, {Ralph L} and Romano, {Jose G}",
year = "2018",
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pages = "638--645",
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T1 - Predictors of Thrombolysis Administration in Mild Stroke

T2 - Florida-Puerto Rico Collaboration to Reduce Stroke Disparities

AU - FL-PR CReSD Investigators and Collaborators

AU - Asdaghi, Negar

AU - Wang, Kefeng

AU - Ciliberti-Vargas, Maria A.

AU - Gutierrez, Carolina Marinovic

AU - Koch, Sebastian

AU - Gardener, Hannah

AU - Dong, Chuanhui

AU - Rose, David Z.

AU - Garcia, Enid J.

AU - Burgin, W. Scott

AU - Zevallos, Juan Carlos

AU - Rundek, Tatjana

AU - Sacco, Ralph L

AU - Romano, Jose G

PY - 2018/3/1

Y1 - 2018/3/1

N2 - METHODS: Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis.RESULTS: We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration.BACKGROUND AND PURPOSE: Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).CONCLUSIONS: Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.

AB - METHODS: Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis.RESULTS: We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus ≥3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster door-to-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration.BACKGROUND AND PURPOSE: Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).CONCLUSIONS: Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke.

KW - Florida

KW - Puerto Rico

KW - risk factors

KW - stroke

KW - therapy

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U2 - 10.1161/STROKEAHA.117.019341

DO - 10.1161/STROKEAHA.117.019341

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JO - Stroke

JF - Stroke

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