Hemorrhagic transformation in acute ischemic stroke. Potential contributing factors in the European Cooperative Acute Stroke Study.
OBJECTIVE
Recent studies suggest that thrombolytic therapy may be of benefit to patients with acute ischemic stroke. However, the treatment also carries a significant risk of hemorrhagic transformation (HT). The purpose of this study was to select potential contributors to HT.


METHODS
We provide an explanatory analysis of the European Cooperative Acute Stroke Study (ECASS) data. ECASS was a multicenter, placebo-controlled, randomized trial of recombinant tissue plasminogen activator in ischemic stroke, within 6 hours of symptom onset, which enrolled 620 patients. HTs were classified into either hemorrhagic infarction or parenchymal hemorrhage according to their CT scan appearance. We used logistic regression analysis to select potential contributing factors to each type of HT.


RESULTS
The severity of initial clinical deficit (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.6 to 4.0) and the presence of early ischemic changes on CT scan (OR, 3.5; 95% CI, 2.3 to 5.3) were associated with increased risk of hemorrhagic infarction. Increasing age (in decades; OR, 1.3; 95% CI, 1.0 to 1.7) and treatment with recombinant tissue plasminogen activator (OR, 3.6; 95% CI, 2.1 to 6.1) were related to the risk of parenchymal hemorrhage.


CONCLUSIONS
Since all potential contributing factors are readily discernible upon hospital admission, they should be used to improve selection of patients into future studies.
Larrue
V
V
Department of Neurology, Hôpital de Rangueil, University of Toulouse, France.
von Kummer
R
R
del Zoppo
G
G
Bluhmki
E
E
D000208:Acute Disease; D000368:Aged; D000375:Aging / Q000502:physiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator