Intravenous Thrombolysis for Treatment of Pediatric Acute Ischemic Stroke: Analysis of 20 Years of Population-Level Data in the United States

Authors

Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla, NY, USA.
Steven D. Shapiro, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Rolla Nuoman, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Haris Kamal, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Philip Overby, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow
Gurmeen Kaur, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Ji Y. Chong, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow
Johanna T. Fifi, Departments of Neurology and Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
Neha Dangayach, Departments of Neurology and Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
Eliza C. Miller, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.Follow
Shadi Yaghi, Department of Neurology, Rhode Island Hospital at the Warren Alpert Medical School of Brown University, Providence, RI, USA.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow

Author Type(s)

Faculty

DOI

10.1177/17474930221130911

Journal Title

International Journal of Stroke

First Page

555

Last Page

561

Document Type

Article

Publication Date

6-1-2023

Department

Pediatrics

Second Department

Neurology

Abstract

BACKGROUND AND AIMS: Although intravenous thrombolysis (IVT) represents standard-of-care treatment for acute ischemic stroke (AIS) in eligible adult patients, definitive evidence-based guidelines and randomized clinical trial data evaluating its safety and efficacy in the pediatric population remain absent from the literature. We aimed to evaluate the utilization and outcomes of IVT for the treatment of pediatric AIS using a large national registry. METHODS: Weighted hospitalizations for pediatric (<18 years of age) AIS patients were identified in the National Inpatient Sample during the period of 2001 to 2019. Complex sample statistical methods were performed to assess unadjusted and adjusted outcomes in patients treated with IVT or other medical management. RESULTS: Among 13,901 pediatric AIS patients, 270 (1.9%) were treated with IVT monotherapy (median age 12.8 years). IVT-treated patients developed any intracranial hemorrhage (ICH) at a rate of 5.6% (n = 15), and 71.9% (n = 194) experienced favorable functional outcomes at discharge (to home or to acute rehabilitation). Following propensity-score adjustment for age, acute stroke severity, infarct location, and etiological/comorbid conditions, IVT was not associated with an increased risk of any ICH (5.6% vs 5.4%, p = 0.931; adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI) = 0.48-2.14, p = 0.971), nor with favorable functional outcome (71.9% vs 74.5%, p = 0.489; aOR = 0.88, 95% CI = 0.60-1.29, p = 0.511) in comparison with other medical therapy. CONCLUSIONS: Twenty years of population-level data in the United States demonstrate that pediatric AIS patients treated with IVT experienced high rates of favorable outcomes without an increased risk of hemorrhagic transformation.

Recommended Citation

Dicpinigaitis, A. J., Shapiro, S. D., Nuoman, R., Kamal, H., Overby, P., Kaur, G., Chong, J. Y., Fifi, J. T., Dangayach, N., Miller, E. C., Yaghi, S., & Al-Mufti, F. (2023). Intravenous Thrombolysis for Treatment of Pediatric Acute Ischemic Stroke: Analysis of 20 Years of Population-Level Data in the United States. International Journal of Stroke, 18 (5), 555-561. https://doi.org/10.1177/17474930221130911