Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?

Ameer E. Hassan, Saqib A. Chaudhry, Vishal Jani, Mikayel Grigoryan, Asif A. Khan, Malik Adil, Adnan I. Qureshi

Research output: Contribution to journalArticle

Abstract

Background: The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data from all patients admitted to US hospitals between 2002 and 2009 who were treated with IV thrombolysis and who had a primary discharge diagnosis of stroke were included. The effect of obesity on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results: Of the 81,579 patients with ischemic stroke treated with IV rt-PA, 5174 (6.3%) were categorized as obese. The intracerebral hemorrhage rates in obese and nonobese patients were significantly different (4.5% v 6.3%; P = .01). After adjusting for age, sex, presence of hypertension, diabetes mellitus, location/teaching status and All Patient Refined Diagnosis Related Group severity scale, there was no difference in the rates of no to minimal disability between obese and nonobese patients (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.8-1.2; P =.8). Obese patients had lower odds of in-hospital mortality (OR 0.6; 95% CI 0.5-0.8; P =.001) but also more likely to be discharged with moderate to severe disability (OR 1.2; 95% CI 1.01-1.3; P =.03). Conclusions: Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.

Original languageEnglish (US)
Pages (from-to)545-549
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number4
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Fingerprint

Cerebral Hemorrhage
Stroke
Mortality
Tissue Plasminogen Activator
Odds Ratio
Confidence Intervals
Obesity
Diagnosis-Related Groups
Hospital Mortality
Diabetes Mellitus
Teaching
Survival Rate
Logistic Models
Regression Analysis
Guidelines
Hypertension

Keywords

  • Acute ischemic stroke
  • cerebral infarction
  • obesity
  • outcomes
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke? / Hassan, Ameer E.; Chaudhry, Saqib A.; Jani, Vishal; Grigoryan, Mikayel; Khan, Asif A.; Adil, Malik; Qureshi, Adnan I.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 4, 01.01.2013, p. 545-549.

Research output: Contribution to journalArticle

Hassan, Ameer E. ; Chaudhry, Saqib A. ; Jani, Vishal ; Grigoryan, Mikayel ; Khan, Asif A. ; Adil, Malik ; Qureshi, Adnan I. / Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 4. pp. 545-549.
@article{bf2d2e2eb9564ce88f5c6bc509752411,
title = "Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?",
abstract = "Background: The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data from all patients admitted to US hospitals between 2002 and 2009 who were treated with IV thrombolysis and who had a primary discharge diagnosis of stroke were included. The effect of obesity on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results: Of the 81,579 patients with ischemic stroke treated with IV rt-PA, 5174 (6.3{\%}) were categorized as obese. The intracerebral hemorrhage rates in obese and nonobese patients were significantly different (4.5{\%} v 6.3{\%}; P = .01). After adjusting for age, sex, presence of hypertension, diabetes mellitus, location/teaching status and All Patient Refined Diagnosis Related Group severity scale, there was no difference in the rates of no to minimal disability between obese and nonobese patients (odds ratio [OR] 1.0; 95{\%} confidence interval [CI] 0.8-1.2; P =.8). Obese patients had lower odds of in-hospital mortality (OR 0.6; 95{\%} CI 0.5-0.8; P =.001) but also more likely to be discharged with moderate to severe disability (OR 1.2; 95{\%} CI 1.01-1.3; P =.03). Conclusions: Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.",
keywords = "Acute ischemic stroke, cerebral infarction, obesity, outcomes, thrombolysis",
author = "Hassan, {Ameer E.} and Chaudhry, {Saqib A.} and Vishal Jani and Mikayel Grigoryan and Khan, {Asif A.} and Malik Adil and Qureshi, {Adnan I.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.jstrokecerebrovasdis.2013.01.022",
language = "English (US)",
volume = "22",
pages = "545--549",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?

AU - Hassan, Ameer E.

AU - Chaudhry, Saqib A.

AU - Jani, Vishal

AU - Grigoryan, Mikayel

AU - Khan, Asif A.

AU - Adil, Malik

AU - Qureshi, Adnan I.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data from all patients admitted to US hospitals between 2002 and 2009 who were treated with IV thrombolysis and who had a primary discharge diagnosis of stroke were included. The effect of obesity on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results: Of the 81,579 patients with ischemic stroke treated with IV rt-PA, 5174 (6.3%) were categorized as obese. The intracerebral hemorrhage rates in obese and nonobese patients were significantly different (4.5% v 6.3%; P = .01). After adjusting for age, sex, presence of hypertension, diabetes mellitus, location/teaching status and All Patient Refined Diagnosis Related Group severity scale, there was no difference in the rates of no to minimal disability between obese and nonobese patients (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.8-1.2; P =.8). Obese patients had lower odds of in-hospital mortality (OR 0.6; 95% CI 0.5-0.8; P =.001) but also more likely to be discharged with moderate to severe disability (OR 1.2; 95% CI 1.01-1.3; P =.03). Conclusions: Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.

AB - Background: The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data from all patients admitted to US hospitals between 2002 and 2009 who were treated with IV thrombolysis and who had a primary discharge diagnosis of stroke were included. The effect of obesity on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results: Of the 81,579 patients with ischemic stroke treated with IV rt-PA, 5174 (6.3%) were categorized as obese. The intracerebral hemorrhage rates in obese and nonobese patients were significantly different (4.5% v 6.3%; P = .01). After adjusting for age, sex, presence of hypertension, diabetes mellitus, location/teaching status and All Patient Refined Diagnosis Related Group severity scale, there was no difference in the rates of no to minimal disability between obese and nonobese patients (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.8-1.2; P =.8). Obese patients had lower odds of in-hospital mortality (OR 0.6; 95% CI 0.5-0.8; P =.001) but also more likely to be discharged with moderate to severe disability (OR 1.2; 95% CI 1.01-1.3; P =.03). Conclusions: Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.

KW - Acute ischemic stroke

KW - cerebral infarction

KW - obesity

KW - outcomes

KW - thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=84877066795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84877066795&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2013.01.022

DO - 10.1016/j.jstrokecerebrovasdis.2013.01.022

M3 - Article

C2 - 23453555

AN - SCOPUS:84877066795

VL - 22

SP - 545

EP - 549

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 4

ER -