Inpatient outcomes after acute ischemic stroke in patients with leukemia: A retrospective observational cohort study

Abstract: INTRODUCTION: Leukemia is associated with a greater risk of stroke due to increased hypercoagulability and introduction of treatment modalities that increase the risk of thrombosis. METHODS: Using the 2015–2022 National Inpatient Sample database, a retrospective observational cohort study was completed. This nationally representative sample included patients ≥ 18 years old in the United States, hospitalized primarily with AIS and an existing diagnosis of leukemia. Outcomes included the likelihood of inpatient mortality, routine discharge to home without additional care, complications, comorbidities, treatment, and reperfusion therapy. RESULTS: A total of 14,770 patients with stroke and leukemia were identified. Patients with leukemia and AIS had significantly decreased odds of smoking history, diabetes, dyslipidemia, and hypertension ( P < 0.001). There were also significantly lower odds of dysphagia, hemiplegia, and cerebral edema/herniation ( P < 0.01) and decreased odds of EVT and IVT ( P < 0.001) in this population. The likelihood of hemorrhagic conversion was lower for patients with leukemia ( P < 0.001) and was equivalent after reperfusion therapy between the two groups. There was no significant difference in odds of routine discharge and mortality and decreased odds of transfer to other facilities between patients hospitalized for AIS with and without leukemia. DISCUSSION: While leukemia itself represents a heterogeneous group of disease mechanisms, patients with AIS and leukemia were older, had increased comorbidity indices, and longer hospital stays. However, the leukemia AIS group was less likely to receive reperfusion therapy, potentially because of the lack of guidelines for acute treatment of stroke in this population. CONCLUSION: Ultimately, our study provides a foundation for future research on understanding the relationship between leukemia and stroke.