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Drug Safety/Pharmacovigilance

039: Incidence & Predictors of Stroke Mimic Amongst Patients Treated With Recombinant Tissue Plasminogen Activator: A Retrospective Comparison

Sunday, September 8, 2024
5:00 PM – 7:00 PM ET
Statement of Purpose, Innovation or Hypothesis: Differentiating acute ischemic stroke (AIS) patients from those with stroke mimic (SM) is a common diagnostic challenge due to the short eligibility time window for intravenous thrombolysis. Recent analytic modeling suggests there is a threshold portion of 30% SM above which the decision to administer thrombolysis is no longer cost-effective.1 As such, it is imperative for institutions to consider SM prediction in managing acute stroke care costs and avoiding potential patient harms. Current SM prediction scales rely on patient examination and history which can be non-specific and/or difficult in the setting of cognitive impairment. This study will also review data such as medication histories and pre-thrombolytic biomarkers for predictive value.

Description of Methods & Materials: We performed a retrospective review of suspected AIS patients who received intravenous recombinant tissue plasminogen activator (rtPA) alteplase from January 2016 to June 2021 at two medical centers. Stroke mimic (SM) cases were defined by negative diffusion-weighted images (DWI) indicating the lack of acute ischemic lesion, occlusion, or stroke following receipt of intravenous rtPA.

Data & Results:

Among 879 presumed AIS patients who received rtPA during the study period, 603 (69%) had MRI brain with DWI completed. SM was identified in 39% of patients with MRI studies and 27% of all patients treated with rtPA during the study period. The percentages of SM were similar between patients who received tele-stroke consultation and those that received care at a comprehensive stroke center, 39.8% versus 39.2%, respectively, amongst patients with documented MRI. Multivariable regression analysis for SM prediction is pending.

Interpretation, Conclusion or Significance: SM rates remain high amongst patients treated with rtPA. Decision‐support tools and SM prediction variables may help clinicians consider alternate diagnoses, manage costs, and prevent unnecessary exposure to systemic thrombolytics for patients undergoing acute ischemic stroke evaluation.

Disclosures: None

Citations/References: 1. Liberman AL, Choi HJ, French DD, Prabhakaran S. Is the Cost-Effectiveness of Stroke Thrombolysis Affected by Proportion of Stroke Mimics? Stroke. 2019 Feb;50(2):463-468. doi: 10.1161/STROKEAHA.118.022857. PMID: 30572813; PMCID: PMC6349501.

Additional Information/Authors: None