Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.
The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD.



We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA. Multivariable logistic regression models using generalized estimating equations were used to assess outcomes.



From 2 016 652 stroke patients admitted to Get With The Guidelines-Stroke sites in the United States, 832 SCD and 3328 non-SCD controls with no differences in admission National Institutes of Health Stroke Scale or blood pressure were identified. Neither the fraction receiving thrombolytic therapy (8.2% for SCD versus 9.4% non-SCD) nor symptomatic intracranial hemorrhage (4.9% of SCD versus 3.2% non-SCD;P=0.4502) was different. There was no difference in a prespecified set of outcome measures for those with SCD compared with controls.



Coexistent SCD had no significant impact on the safety or outcome of thrombolytic therapy in acute ischemic stroke. Although the sample size is relatively small, these data suggest that adults with SCD and acute ischemic stroke should be treated with thrombolysis, if they otherwise qualify. Addition studies, however, should track the intracranial hemorrhage rate and provide information on other SCD-related care such as transfusion.
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.). adamsrj@musc.edu.
Robert J
RJ
Adams
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Margueritte
M
Cox
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Shelly D
SD
Ozark
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Julie
J
Kanter
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Phillip J
PJ
Schulte
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Ying
Y
Xian
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Gregg C
GC
Fonarow
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Eric E
EE
Smith
From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
Lee H
LH
Schwamm
D000368:Aged; D000369:Aged, 80 and over; D000755:Anemia, Sickle Cell / Q000150:complications*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
brain infarction; quality improvement; sickle cell disease; stroke; thrombolytic therapy