Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Psychiatric Disease, Lower Rates of IVT Linked

Stroke; ePub 2018 Jan 26; Bongiorno, et al

Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of intravenous thrombolysis (IVT), according to a recent study. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care. Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, researchers tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. They found:

  • Of the 325,009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities.
  • IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease.
  • Presence of any psychiatric disease was associated with lower odds of receiving IVT.
  • When psychiatric diagnoses were analyzed separately, individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease.
Citation:

Bongiorno DM, Daumit GL, Gottesman RF, Faigle R. Comorbid psychiatric disease is associated with lower rates of thrombolysis in ischemic stroke. [Published online ahead of print January 26, 2018]. Stroke. doi:10.1161/STROKEAHA.117.020295.

This Week's Must Reads

Hospital Readmission After Seizure Discharge, Neurology; ePub 2018 Dec 21; Blank, et al

VP Shunts and Post-Operative Complications Assessed, J Stroke Cerebrovasc Dis; ePub 2018 Dec 20; Linzey, et al

Disparities in Inter-Hospital Helicopter Transport, J Stroke Cerebrovasc Dis; ePub 2018 Dec 11; Sarrazin, et al

Mild-to-Moderate OSA Linked with Hypertension, Sleep; ePub 2018 Dec 22; Vgontzas, et al

Aspirin Reduces Stroke Risk in Women with Prior HDP, Neurology; ePub 2018 Dec 26; Miller, Boehme, et al

Must Reads in Stroke

VP Shunts and Post-Operative Complications Assessed, J Stroke Cerebrovasc Dis; ePub 2018 Dec 20; Linzey, et al

Disparities in Inter-Hospital Helicopter Transport, J Stroke Cerebrovasc Dis; ePub 2018 Dec 11; Sarrazin, et al

Aspirin Reduces Stroke Risk in Women with Prior HDP, Neurology; ePub 2018 Dec 26; Miller, Boehme, et al

Pre-existing Hypertension in Patients with Stroke, J Stroke Cerebrovasc Dis; ePub 2018 Dec 13; Valentine, et al

Sex, Race Differences in Ischemic Stroke Examined, JAMA Neurology; ePub 2018 Dec 10; Howard, et al