BACKGROUND: There are no large studies evaluating the safety of thrombolysis for acute stroke in patients with brain tumors and hence, these patients are often excluded from thrombolytic therapy. Our aim is to study stroke outcomes following thrombolysis in patients with primary brain tumors.
METHODS: Acute ischemic stroke (AIS) patients who received thrombolysis were identified from the 2005-2010 Nationwide Inpatient Sample using ICD-9 codes. Patients with primary brain tumor-associated strokes (BTS) including both benign and malignant tumors, and non-brain tumor associated strokes (NBTS) were compared based on demographics, comorbidities, hospital characteristics, and outcomes. Intracranial metastases and spinal tumors were excluded. The main outcomes were in-hospital mortality and intracerebral hemorrhage (ICH).
RESULTS: We identified 2,964,733 patients with AIS from 2005-2010. Thrombolysis was administered to 272 out of 18,441(1.5%) BTS patients, and 89,680 out of 2,856,612 (3%) NBTS patients. BTS correlated with higher age quartiles (p<0.001) and female sex (69.5% vs. 49.7%, p<0.001). While vascular risk factors such as hypertension and hyperlipidemia were similar in the two groups, atrial fibrillation was more common in BTS (42.3% vs. 23.2%, p<0.001). In the univariate analysis, ICH rate after thrombolysis was significantly higher in the BTS cohort (OR: 2.19, CI: 1.57-3.76, p<0.001), while mortality was similar. In the multivariate analysis, there was no difference in hospital mortality between the two groups following thrombolysis; however, ICH remained significantly higher among BTS (OR: 2.16, CI: 1.53- 3.03, p<0.001) after adjusting for confounders. In the regression model on brain tumor patients with AIS, the main predictors of ICH were malignant pathology of tumors (OR: 1.27, CI: 1.05-1.55, p<0.001) and administration of thrombolytic therapy (OR: 5.10, CI: 3.55-7.35, p<0.001).
CONCLUSIONS: Thrombolytic therapy for acute stroke in patients with primary brain tumors is associated with increased risk of ICH. Cardioembolic strokes appear to be more common in BTS. Stroke outcomes following thrombolysis are less favorable in malignant brain tumors compared to benign tumors. Prospective confirmation is warranted.
