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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.

Publication ,  Journal Article
Adams, RJ; Cox, M; Ozark, SD; Kanter, J; Schulte, PJ; Xian, Y; Fonarow, GC; Smith, EE; Schwamm, LH
Published in: Stroke
March 2017

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

March 2017

Volume

48

Issue

3

Start / End Page

686 / 691

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Stroke
  • Practice Guidelines as Topic
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Intracranial Hemorrhages
  • Humans
 

Citation

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Chicago
ICMJE
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Adams, R. J., Cox, M., Ozark, S. D., Kanter, J., Schulte, P. J., Xian, Y., … Schwamm, L. H. (2017). 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. Stroke, 48(3), 686–691. https://doi.org/10.1161/STROKEAHA.116.015412
Adams, Robert J., Margueritte Cox, Shelly D. Ozark, Julie Kanter, Phillip J. Schulte, Ying Xian, Gregg C. Fonarow, Eric E. Smith, and Lee H. Schwamm. “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.Stroke 48, no. 3 (March 2017): 686–91. https://doi.org/10.1161/STROKEAHA.116.015412.
Adams, Robert J., et al. “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.Stroke, vol. 48, no. 3, Mar. 2017, pp. 686–91. Pubmed, doi:10.1161/STROKEAHA.116.015412.
Adams RJ, Cox M, Ozark SD, Kanter J, Schulte PJ, Xian Y, Fonarow GC, Smith EE, Schwamm LH. 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. Stroke. 2017 Mar;48(3):686–691.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

March 2017

Volume

48

Issue

3

Start / End Page

686 / 691

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Stroke
  • Practice Guidelines as Topic
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Intracranial Hemorrhages
  • Humans