BACKGROUND: Stroke during pregnancy is a rare but potentially devastating event. Reported experience with thrombolysis in pregnant patients is limited. Our aim is to study outcomes of thrombolysis in stroke associated with pregnancy by using Nationwide Inpatient Sample (NIS).
METHODS: Pregnant patients with Acute Ischemic Stroke (AIS) were identified from the 2005-2010 NIS using International Classification of Diseases, Ninth Revision (ICD-9) codes. Pregnant patients who received thrombolysis were compared with those who did not receive thrombolysis based on demographics, comorbidities, hospital characteristics, and outcomes. The main outcomes were in-hospital mortality, home-discharge and intracerebral hemorrhage (ICH).
RESULTS: We identified 2603 pregnant patients admitted with a diagnosis of AIS, of whom 56 (2.15%) of received thrombolysis. Pregnant patients with AIS were more likely to be treated with thrombolysis at teaching hospitals compared to non-teaching hospitals (2.78% vs 1.06%, p<0.05). Pregnant patients with AIS also had more severe Elixhauser comorbidity scores (p<0.001). Thrombolysis in pregnant patients was associated with higher in-hospital moratlity rate (26.8% vs 4.6%, p<0.001) and lower home discharge rate (44.6% vs 60.1% , p<0.05) but similar rate of ICH. In the regression model on pregnant patients with AIS, the main independent predictors of in-hospital mortality were thrombolysis (OR: 5.97, CI: 3.01-11.84, p<0.001) and ICH (OR: 2.34, CI: 1.34-4.07, p<0.001).
CONCLUSIONS: Stroke outcomes following thrombolysis appears to be less favorable in pregnant patients. Prospective confirmation of these findings is warranted.
