RAcial Disparities in Ich after IV-tPA and Neurointerventional Treatment (RADIANT)

J Stroke Cerebrovasc Dis. 2020 Feb;29(2):104474. doi: 10.1016/j.jstrokecerebrovasdis.2019.104474. Epub 2019 Nov 26.

Abstract

Objective: To study the rate of symptomatic intracerebral hemorrhage (SxICH) and major systemic hemorrhage (MSH) after acute stroke treatments among different ethnicities/races.

Background: Studies have reported ethnic/racial disparities in intravenous tPA treatment (IV tPA). The adverse outcome of tPA and/or intra-arterial intervention (IA) among different ethnicities/races requires investigation.

Methods: We retrospectively reviewed all patients from an IRB-approved registry between June 2004 and June 2018. Patients who received IV tPA, IA, or both for acute stroke were identified and classified into 2 ethnic groups: non-Hispanics or Hispanics (NH/H) and 4 racial groups: Asian, Black, Other (Native Americans and Pacific Islanders), and White (A/B/O/W).

Results: We identified 916 patients that received acute therapy (A/B/O/W: n = 50/104/16/746, H/NH: n = 184/730). For those received IV tPA only (n = 759), IA only (n = 85), and IV tPA+IA (n = 72), the SxICH rate was 4.3%, 4.7%, and 6.9%; the MSH rate was 1.3%, 0%, and 0%, respectively. No significant difference in the rate of SxICH or MSH among different racial or ethnic groups was found after either therapy. Asian race (OR 14.17, P = .01), in association with age, international normalized value (INR), and Partial thromboplastin time (PTT) (OR 1.06, 46.52, and 1.18, P = .020, 0.037, and 0.042, respectively), was predictive of SxICH after IV tPA. There was a significant correlation between age and National Institute of Health Stroke Scale with SxICH (P < .01, P = .02, respectively). Age, INR, and PTT were independent predictors of SxICH after IV tPA (OR 1.06, 46.52, and 1.18, P = .02, 0.04, and 0.04, respectively).

Conclusions: There was no significant difference in the rate of SxICH or MSH after IV tPA, IA, or IV tPA+IA among different racial or ethnic groups. Larger studies are needed to elucidate the race specific causes of SxICH and MSH after acute stroke treatment.

Keywords: IV-tPA; Intracerebral hemorrhage; ethnicity; mechanical thrombectomy; racial disparities.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Asian
  • Black or African American
  • California / epidemiology
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / ethnology
  • Combined Modality Therapy
  • Endovascular Procedures* / adverse effects
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Infusions, Intravenous
  • International Normalized Ratio
  • Partial Thromboplastin Time
  • Racial Groups*
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / ethnology*
  • Stroke / therapy*
  • Thrombectomy* / adverse effects
  • Thrombolytic Therapy* / adverse effects
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome
  • White People

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator