title: In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors.
abstract: Data on thrombolysis outcomes in patients with primary brain tumors are limited. Our aim was to study stroke outcomes following thrombolysis in these patients in a population-based study. Patients with acute ischemic stroke who received thrombolysis were identified from the 2002-2011 USA Nationwide Inpatient Sample. We compared demographics, comorbidities, and outcomes between primary brain tumor-associated strokes (BTS) and non-brain tumor associated strokes (NBTS). The main outcomes were inpatient mortality, home discharge and intracranial hemorrhage (ICH) rate. Of the 124,083 thrombolysis-treated stroke patients, 416 (0.34%) had brain tumors. In adjusted analysis, inpatient mortality (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.77-1.26, p=0.918), rate of home discharge (OR: 1.15; 95% CI: 0.87-1.53, p=0.40) and rate of ICH (OR: 0.94; 95% CI: 0.62-1.44, p=0.801) were similar between BTS and NBTS. Analysis of brain tumor subtypes showed that compared to NBTS, malignant BTS were independently associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.66-3.79, p<0.001), lower home discharge (OR: 0.36, 95% CI: 0.18-0.72, p=0.004), and increased risk of ICH (OR: 2.33, 95% CI: 1.49-3.65, p<0.001). Additionally, among the BTS, intraparenchymal location of tumor was associated with higher mortality (OR: 2.51; 95% CI: 1.20-5.23, p=0.014) and lower home discharge (OR: 0.26; 95% CI: 0.13-0.53, p<0.001). Thrombolytic therapy for acute stroke appears to be safe in patients with primary brain tumors, with similar rates of ICH. Malignant BTS have worse outcomes, while benign BTS have outcomes comparable to NBTS. Careful consideration of tumor pathology may aid selection of patients with poor thrombolysis outcomes.
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, 600 N Wolf Street, Meyer 8-140, MD 21287, USA. Electronic address: santoshbmurthy@gmail.com.
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, 600 N Wolf Street, Meyer 8-140, MD 21287, USA.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Moradiya
authors.affiliation: Department of Vascular Neurology, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Shreyansh
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Hematology and Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Aditi
authors.initials: A
authors.lastname: Shastri
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Bershad
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D001932:Brain Neoplasms / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute stroke; Nationwide inpatient sample; Primary brain tumors; Thrombolysis