In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke.
BACKGROUND
Thrombolytic therapy is an effective treatment modality for acute ischaemic stroke within 3 hours of symptom onset. Its safety and efficacy have not been studied in patients with chronic kidney disease (CKD), who are known to have abnormalities in coagulation and platelet function.


METHODS
We studied all patients who consecutively received intravenous thrombolytic therapy for acute stroke at our hospital from 2005-2009 (n = 74). Alteplase was administered to patients deemed eligible by National Institute of Health criteria per protocol. We studied associations between admission renal dysfunction [estimated glomerular filtration rate (eGFR) <60ml/min/1.73 m(2)] and in-hospital outcomes: intracranial haemorrhage (ICH), poor functional status (modified Rankin score 3-6) and death.


RESULTS
Mean +/- SD age was 66.4 +/- 16.9 years with 39 (52.7%) men and 46 (62.2%) Caucasian. Twenty patients (27.0%) had eGFR <60 and were older, with a higher prevalence of diabetes and coronary artery disease than patients with eGFR > or =60. Presenting stroke severity, blood pressure and time to alteplase were similar in the two groups. Symptomatic ICH occurred in two patients with eGFR > or =60. Asymptomatic and symptomatic ICH considered together showed no difference in these event rates (20% in eGFR <60 vs 11.1% in eGFR > or =60, P = 0.321). There was no difference in poor functional status (70.0% in eGFR <60 vs 57.4% in eGFR > or =60, P = 0.324) or in-hospital death outcomes (10.0% in eGFR <60 vs 7.4% in eGFR > or =60, P = 0.717). Multivariate logistic regression analysis revealed no association between eGFR <60 and in-hospital outcomes, while increasing age was associated with poor functional status [odds ratio 1.03 (1.00-1.06, P = 0.047)].


CONCLUSIONS
In our limited sample size study, presence of eGFR <60 in patients receiving thrombolytic therapy for acute stroke was not found to be associated with increased ICH, poor functional outcome or death. These findings suggest that use of thrombolytics in acute stroke is appropriate in patients with renal dysfunction.
Agrawal
Varun
V
Renal Division, Baystate Medical Center, Springfield MA, USA. varunagrawal1996@yahoo.com
Rai
Baroon
B
Fellows
Jonathan
J
McCullough
Peter A
PA
D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy; D007511:Ischemia / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator