Use and in-hospital outcomes of recombinant tissue plasminogen activator in pediatric arterial ischemic stroke patients

Background Outcomes in pediatric stroke are poorly understood. We sought to determine trends in the use of recombinant tissue plasminogen activator (rt-PA), treatment outcomes, and predictors of mortality for pediatric patients with acute ischemic stroke by using the Nationwide Inpatient Sample.

Methods Using Nationwide Inpatient Sample data from 2001 to 2010, we identified pediatric patients (age 30 days to 18 years) with the primary diagnosis of arterial ischemic stroke. We studied trends of use of intravenous rt-PA and outcomes after thrombolysis. We also analyzed the associations of demographic factors, comorbidities, and complications of arterial ischemic stroke with in-hospital mortality.

Results This study included 7044 patients. In-hospital mortality was 4.7%. The comorbidities associated with the greatest rates of in-hospital mortality were mitochondrial disorders (19.5%, P < 0.0001) and hypercoagulable states (11.4%, P < 0.0001). The main complications associated with increased mortality were intracerebral hemorrhage (19.9%, P < 0.0001), sepsis (13.2%, P < 0.0001), and pneumonia (9.3%, P = 0.0007). The rate of rt-PA use was 1.4% (99 patients). rt-PA use increased from 0.9% of patients in 2001-2005 to 2.0% in 2006-2010 (P < 0.0001). Among patients who received rt-PA, the rate of intracerebral hemorrhage was low and without fatalities; however, there was an increased discharge-to-long-term-facilities rate in the rt-PA group (50.8% versus 12.1%, P < 0.0001). Conclusion Arterial ischemic stroke in the pediatric population is associated with a greater rate of mortality when related to mitochondrial diseases or hypercoagulability. rt-PA use is increasing in pediatric patients with arterial ischemic stroke. Pediatric patients receiving rt-PA have a low risk of fatal hemorrhage. Although patients receiving rt-PA have a morbidity rate, these individuals may have a worse stroke severity.