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Stroke dovetails with spikes in opioid misuse, infective endocarditis

Elvira Manzano
25 Feb 2019

Hospitalization rates for stroke increased by 20 percent each year between 2008 and 2015, according to a large US study, and these incidents were apparently tied to spikes in opioid misuse and cases of drug-related infective endocarditis.

The biggest take away for clinicians is to keep in mind that “stroke is a complication of opioid misuse that we need to be concerned about, especially for younger patients who are using more opioids now,” said lead author Dr Setareh Salehi Omran from the Weill Cornell Medical Center and Columbia University Medical Center, New York City, New York, US said. They should be concerned when a patient comes into the hospital on a background of intravenous opioid use and infective endocarditis as that patient may be at risk for stroke, she added.

There were 14,429,338 stroke-related hospitalizations, 12,169,131 opioid use-related hospitalizations, and 815,482 infective endocarditis-related hospitalizations from 1993 to 2015. As for stroke hospitalization related to both endocarditis and opioid use, there were about 5,283 cases during the same study period. The greatest increases in stroke hospitalization rates were in women, patients of non-Hispanic descent living in northeastern and southern US, and those aged <45 years. [ICS 2019, abstract 8; Stroke 2019;doi:10.1161/STROKEAHA.118.024436]

Omran and her team analysed inpatient discharge data (1993–2015) from the Healthcare Cost and Utilization Project’s National Inpatient Sample and identified hospitalizations for stroke (ischaemic or haemorrhagic) associated with opioid use and infective endocarditis.

The annual percent change (APC) in stroke hospitalization from 2008 to 2015 was significant at 20.3 percent (95 percent confidence interval (CI), 10.5- 30.9 percent). Hospitalizations for stroke associated with both infective endocarditis and opioid use increased from 2.4 (95 percent CI, 0.5 – 4.3) per 10 million US residents per year in 1993 to 18.8 (95 percent CI, 14.4–23.3) per 10 million in 2015.

Hospitalizations for stroke were higher in patients <45 years between 2006 and 2015 (APC, 20.5 percent), and in women between 2008 and 2015. Patients of non-Hispanic descent had the most significant increase in rates of hospitalization for stroke (1.0 –24.3 per 10 million US residents between 1993 and 2015).  Ischaemic stroke accounted for 71.5 percent of hospitalizations, haemorrhagic stroke for 28.5 percent.

Infective endocarditis, a cardiovascular complication of intravenous opioid use, results from endothelial damage related to repetitive injections and introduction of bacteria into the bloodstream via unsterile needles and preparation techniques, said Omran. Stroke is a neurological complication affecting 20 percent of patients with infective endocarditis. However, data on recent trends in stroke, as a complication of opioid-related infective endocarditis, remain scant particularly those relevant to the spiralling opioid epidemic, until the current study.

“Our findings add to the urgency of addressing the underlying opioid epidemic in the US and suggest a need for improved awareness of the cerebrovascular complications of opioid abuse,” said the researchers.

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