Master of Science
Epidemiology and Biostatistics
Dr. Amit Garg
The outcomes of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke among patients with reduced kidney function are uncertain. We conducted a retrospective cohort study between 2002-2013 to describe rt-PA use and the risk of secondary intracranial hemorrhage (ICH) and disability at discharge. In an overlap weighted cohort of rt-PA eligible patients (1,354), the relative risk (RR) of secondary ICH among those who received rt-PA (vs. no rt-PA) was 2.56 (99% confidence interval (CI) 1.77-3.69) in those with an estimated glomerular filtration rate (eGFR) ≥60, and 2.67 (2.17-6.20) in those with an eGFR 30-59 mL/min/1.73m2. Those treated with rt-PA were more likely to be discharged alive and independent compared no rt-PA (RR ≥60: 1.34 (1.17-1.53), 30-59: 1.53 (1.21-1.93) and, <30/chronic dialysis: 2.13 (0.80-5.67)). rt-PA treated patients versus no rt-PA have a higher risk of bleeding but also have a greater chance of leaving hospital alive and independent.
Summary for Lay Audience
A commonly used drug to treat a stroke from a blood clot, tissue plasminogen activator, may be harmful to those whose kidneys do not work properly. We designed a study to understand how this drug treatment is used in people with different levels of kidney function and whether it is safe and works well. Among adults living in Ontario, Canada who had an acute ischemic stroke, we found that this drug treatment is given to people at all levels of kidney function. In a smaller group of people who met the criteria for receiving this treatment, we found that patients with normal and reduced kidney function who received the treatment were 3 times more likely to bleed into their brains than those who did not receive the treatment. At the same time, those who received the treatment were up to 2 times more likely to leave the hospital alive with independent function than those who did not receive the treatment. Across all levels of kidney function, we conclude that those who did versus did not receive treatment are more likely to bleed but also are more likely to leave the hospital alive with independent function.
Bota, Sarah E., "Recombinant Tissue Plasminogen Activator Therapy for Acute Ischemic Stroke in Patients with Chronic Kidney Disease" (2021). Electronic Thesis and Dissertation Repository. 7847.
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