The 2018 American Heart/Stroke Association Guidelines recommend against the use of IV thrombolytics (Class III) in patients with AIS when presenting with signs of IE, secondary to risk of ICH. However, limited data are available on the utility of MT within this cohort.

To determine from the Nationwide Inpatient Sample (NIS), the prevelance of intracranial hemorrhage (ICH) and mortality trends, associated with the use of tPA and mechanical thrombectomy (MT), in acute ischemic stroke (AIS) with and without infective-endocarditis (IE).

Using the NIS from 2005-2014, patients with IE who presented with AIS were identified. SAS 9.4 was used for data analysis. Categorical and continuous variables were tested using the Chi-Square test and Student’s t-test, respectively. Cox proportional hazard regression was used to adjust for confounders.

 A total of 4,279,921 (weighted) patients (>18 years) were diagnosed with AIS. Among them 16,015 (0.37%) carried a diagnosis of IE at presentation. IV tPA administration rates were 4.87% (n=208,056) among non-IE and 4.24% (n=679) among patients with IE. There was a higher prevalence of ICH in IV tPA-treated patients who had IE (23.2% vs. 21.0%, p=0.51). However, IV tPA use was associated with a significantly higher mortality in the non-IE cohort vs. IE cohort (8.5% vs. 4.2%, p=0.002). Similar to IV tPA, MT in patients with IE had a higher prevalence of ICH (9.4% vs. 6.1%, p=0.115). However, MT use was associated with a significantly higher mortality among those with IE vs. non-IE group (4.23% vs. 2.39%, p=0.019). After adjusting for confounders, MT in IE-patients was associated with a 5.3 times higher odds of death (p=0.0001), while tPA use was not (0.79, p=0.38).

In a nationally representative sample, MT in AIS patients with IE is associated with a significantly higher mortality. Further research needs to be undertaken to understand the mechanisms of increased mortality.