Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use: A nationwide propensity score-matched follow-up study.
Background Thrombolysis with intravenous recombinant tissue-type plasminogen activator improves functional outcome in acute ischemic stroke. Few studies have investigated the effects of thrombolysis in a real-world setting. We evaluated the impact of thrombolysis on long-term hospital bed day use and the risk of readmission due to stroke-related complications. Methods We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). Thrombolysed patients were propensity-score matched with non-thrombolysed acute ischemic stroke patients admitted to stroke centers not yet offering thrombolysis in 2004-2006. The outcomes were length of the stroke admission, total all-cause hospital bed day use during the first year after the stroke, and the long-term risk of readmissions. Thrombolysed and non-thrombolysed patients were compared using multivariable log-linear regression and Cox regression. Results We identified 1095 thrombolysed and 1095 propensity score matched eligible but non-thrombolysed acute ischemic stroke patients. The median length of the stroke admission was 9 days in the thrombolysed group and 13 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.88; 95% CI: 0.78-1.00). The median all-cause hospital bed day use within the first year was 12 days in the thrombolysed group and 19 days in the non-thrombolysed group (adjusted geometric mean ratio, 0.82; 95% CI: 0.73-0.92). There was no significant difference in the overall risk of readmission (adjusted hazard ratio, 0.91; 95% CI: 0.79-1.04); however, thrombolysis was associated with reduced risk of pneumonia (adjusted hazard ratio, 0.59; 95% CI: 0.35-0.97). Conclusions Thrombolysis in ischemic stroke was associated with lower long-term hospital bed day use and decreased risk of readmission due to pneumonia.
1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
Thorkild
T
Terkelsen
2 Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark.
Marie Louise
ML
Schmitz
3 Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark.
Claus Z
CZ
Simonsen
1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
Heidi H
HH
Hundborg
4 Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Hanne K
HK
Christensen
5 Department of Neurology, Roskilde Hospital, Roskilde, Denmark.
Jesper
J
Gyllenborg
6 Department of Neurology, Holstebro Hospital, Holstebro, Denmark.
Birgitte F
BF
Sandal
7 Department of Neurology, Rigshospitalet, København Ø, Denmark.
Helle K
HK
Iversen
8 Department of Neurology, Odense University Hospital, Odense C, Denmark.
Charlotte
C
Madsen
9 Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark.
Mary-Jette
MJ
Rasmussen
10 Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
Karsten
K
Vestergaard
2 Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark.
Grethe
G
Andersen
1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark.
Søren P
SP
Johnsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D003718:Denmark; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D057216:Propensity Score; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
Ischemic stroke; follow-up study; hospitalization; readmission; tPA; thrombolysis