Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey.
BACKGROUND
Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH.


RESULTS
In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH.


CONCLUSIONS
Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.
Tanne
David
D
Stroke Unit, Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel. tanne@post.tau.ac.il
Kasner
Scott E
SE
Demchuk
Andrew M
AM
Koren-Morag
Nira
N
Hanson
Sandra
S
Grond
Martin
M
Levine
Steven R
SR
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D002170:Canada; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D007275:Injections, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012372:ROC Curve; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012306:Risk; D018570:Risk Assessment; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014481:United States
D015415:Biomarkers; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator