Abstract W MP29: Stroke Severity and Thrombolysis-Induced Intracerebral Haemorrhage: Thrombolysis Practice and Outcomes in England and Wales at the Extremes of the NIHSS

Background: The safety and outcomes of thrombolysis with intravenous tPA in patients with mild stroke or very severe stroke are still debated. We describe the use and outcomes from thrombolysis across the full range of stroke severity in England and Wales. Methods: The Sentinel Stroke National Audit Programme (SSNAP) is the prospective stroke register for England and Wales, with 100% population coverage. Data are entered by clinical teams using a secure online web portal. Symptomatic intracranial haemorrhage (SIH) was defined pragmatically (evidence on imaging plus clinical deterioration). Results: 58,769 ischaemic stroke patients were admitted from April 2013-March 2014, and 7598 (12.9%) received tPA; median NIHSS was 4 (IQR 2-9). Of the 6578 (86.9%) patients treated with tPA with documented NIHSS, 816 (12.4%) were mild (NIHSS 0-4) and 650 (10.0%) were very severe (NIHSS ≥ 22). The overall incidence of SIH was 4.0% (95% CI 3.5-4.5). Risk of SIH increased with stroke severity: 1.4% with NIHSS 0-4, 3.1% wi...