One-year home-time and mortality after thrombolysis compared with nontreated patients in a propensity-matched analysis

Abstract

Background and Purpose-Intravenous thrombolysis with r-tPA (recombinant tissue-type plasminogen activator) isassociated with improved early functional outcome after stroke, but its long-term effects are less understood. We aimedto determine the association between r-tPA and 1-year outcomes after stroke.Methods-We used the Ontario Stroke Registry to identify patients diagnosed with ischemic stroke between 2002 and 2013in Ontario, Canada, their baseline characteristics, and whether they received r-tPA. We used propensity score methodsto match patients treated with r-tPA to nontreated patients. The primary outcome was 1-year home-time, defined as thenumber of days spent outside of any healthcare institutions in the first 365 days after the index date of admission. Secondaryoutcomes were admission to a nursing home and all-cause mortality in the first year. Outcomes were determined usinglinked administrative data. We used paired t tests to compare mean home-time days and Cox proportional hazards modelsfor mortality and nursing home admission to estimate hazard ratios and 95% CI.Results-All 4449 patients treated with r-tPA in the registry were matched to nontreated patients. Compared with nontreatedpatients, those treated with r-tPA experienced more time at home in the first year (mean±SD was 248.9 days±137.2treated versus 239.4 days±139.0 nontreated, P=0.005) and were less likely to be admitted to nursing homes (9.4% treatedversus 12.2% nontreated; hazard ratio, 0.84; 95% CI, 0.78-0.91). One-year all-cause mortality was similar between the2 groups (13.2% treated versus 12.4% nontreated; hazard ratio, 1.07; 95% CI, 0.96-1.20).Conclusions-Despite similar mortality, patients who received r-tPA spent more time at home and were less likely to requirenursing home admission in the first year after stroke compared with nontreated patients, suggesting long-term benefitsand safety of this treatment.