Background: Temporal data on secondary intracerebral hemorrhage (SICH) risk in acute ischemic stroke (AIS) patients (pts) is sparse since implementation of current measures to lessen times to intravenous thrombolysis (tPA) and/or endovascular reperfusion.
Aims: (1) Evaluate trends in SICH prevalence in AIS pts in the United States from 2004-2013 and to compare SICH risk following tPA and mechanical thrombectomy (MT) from 2011-2013 to risk in earlier periods. (2) Assess the magnitude of the current association of SICH with in-hospital morbidities and mortality in AIS.
Methods: All adults with a primary diagnosis of AIS (n=4,355,140) were identified from the 2004-2013 Nationwide Inpatient Sample. We computed weighted risk of SICH in AIS according to age, sex and intervention received (tPA, MT or no-intervention). Multivariate models were used to compare SICH risks in the period 2004-2007 to periods 2008-2010 and 2011-2013, respectively, and to evaluate association of SICH with in-hospital morbidity, mortality, length-of-stay (LOS) and cost.
Results: SICH risk increased over the study period but most of the increase occurred after 2010 (figure 1). From the period 2004-2007 to period 2011-2013, SICH risk increased by 75% in IV tPA pts (4.8%-8.4%), 164% in MT pts (8.1%-21.4%) and by 367.8% in no-intervention pts (0.5%-2.3%). Risks increased with age but only in tPA pts and did not vary by sex in both tPA and MT pts after multivariate adjustment. SICH was associated with >200% increased odds of ventilator use, pneumonia, sepsis, acute renal failure, deep venous thrombosis, pulmonary embolism and 67% reduced odds of home disposition compared to non-SICH. Mortality in SICH decreased from 26% to 18.3% compared to 6.1% to 4.0% in the non-SICH patients over the entire period. SICH was associated with >$8,000 increase in cost and >3-day increase in mean LOS.
Conclusion: The burden of SICH in AIS is growing. Innovative strategies are needed to prevent SICH and/or alleviate its sequelae.