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Int Neuropsychiatr Dis J. 2014 May;2(3):127-135.

Social History Matters-The Impact of Illicit Drug Use on tPA Use and In-Hospital Mortality in Acute Ischemic Stroke.

Author information

1
Department of Neurology, Tulane University Hospital, New Orleans, LA 70112, United States.
2
Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), USA. ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC), USA. ; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, England. ; Department of Neurology, School of Medicine, University of Alabama at Birmingham, United States.
3
Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), USA. ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC), USA.
4
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, England.

Abstract

AIMS:

The objective of this descriptive study was to compare time to medical evaluation, intravenous tissue plasminogen activator (IV tPA) use, and short-term outcomes in illicit drug users compared to non-users presenting with acute ischemic stroke (AIS).

STUDY DESIGN:

This is a retrospective study performed from our stroke registry using deidentified patient information.

PLACE AND DURATION OF STUDY:

Tulane Medical Center Primary Stroke Center (PSC). Consecutive AIS patients presenting to our PSC from July 2008 to December of 2010 were identified from our prospectively collected stroke registry.

METHODOLOGY:

Patients were categorized as toxicology positive (TP) or toxicology negative (TN). We compared baseline characteristics, clinical presentation, tPA use, and short-term outcomes in TP and TN patients.

RESULTS:

Two hundred and sixty-three patients met inclusion criteria (median age 63, 35.4% female, 66.5% Black). Nearly 40% of toxicology screens were positive. Stroke severity was similar with the median National Institute of Health Stroke Scale (NIHSS) of 6 in both groups; however, a higher proportion of TN patients were treated with IV tPA (32.1% vs. 21.2%). After adjustment for time from last seen normal to emergency department arrival (LSN-to-ED arrival), the odds of being treated with tPA for TP patients were similar to TN patients (OR 0.69, 95% CI 0.36-1.31, p=0.255). After adjustment for age, NIHSS, glucose, and tPA, the odds of in-hospital mortality in TP patients was 3 times that of TN patients (OR 3.17, 95% CI 1.07-9.43, p=0.038).

CONCLUSION:

We found that the disparities observed in tPA use were attenuated after adjustment for time from LSN-to-ED arrival, suggesting an area for future intervention. Additionally, we found that TP patients may be at higher risk for in-hospital mortality. Further study on the role of substance abuse in time to ED arrival, tPA use, and outcome in AIS patients is warranted.

KEYWORDS:

Ischemic stroke; substance abuse; thrombolytic therapy; tissue plasminogen activator

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