Pretreatment hemostatic markers of symptomatic intracerebral hemorrhage in patients treated with tissue plasminogen activator.
OBJECTIVE
Symptomatic intracerebral hemorrhage (ICH) is a major complication of thrombolysis in patients with acute ischemic stroke. We analyzed whether baseline hemostatic markers could predict symptomatic ICH (SICH).


METHODS
In a multicenter study of patients treated with intravenous tissue plasminogen activator (t-PA) within 3 hours of stroke onset, we analyzed the following variables: demographic data, vascular risk factors, blood glucose at admission, time from the onset of symptoms to t-PA infusion, blood pressure, neurological deficit measured by the National Institutes of Health Stroke Scale (NIHSS) score, early signs of ischemia on the baseline computed tomography (CT) scan, and protocol deviations. In blood samples, the following markers of coagulation/fibrinolysis were measured before treatment: fibrinogen, prothrombin fragments 1+2, Factor XIII, Factor VII, alpha2 antiplasmin, plasminogen activator inhibitor-1 (PAI-1), and thrombin-activatable fibrinolysis inhibitor. ICH was classified according to the European Cooperative Acute Stroke Study (ECASS) II criteria. SICH was defined as a parenchymal hematoma-1 (PH1) or PH2 type, associated with an increase in > or =4 points on the NIHSS score appearing within 36 hours after infusion.


RESULTS
We studied 114 patients. Mean age was 68.4+/-12.7 years, and 61% were men. The median baseline NIHSS score was 14. Mean time to treatment was 153+/-33 minutes. Eight patients had SICH (7%), and 18 patients (15.7%) had asymptomatic ICH. None of the baseline markers of coagulation/fibrinolysis were associated with SICH. In the multivariate analysis, only NIHSS on admission was an independent risk factor for SICH.


CONCLUSIONS
None of the hemostatic markers analyzed in our study predicted symptomatic cerebral hemorrhage in patients with ischemic stroke treated with t-PA.
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. dcocho@santpau.es
Dolores
D
Cocho
Montserrat
M
Borrell
Joan
J
Martí-Fàbregas
Joan
J
Montaner
Mar
M
Castellanos
Yolanda
Y
Bravo
Laura
L
Molina-Porcel
Roberto
R
Belvís
Jorge-Alberto
JA
Díaz-Manera
Alejandro
A
Martínez-Domeño
María
M
Martínez-Lage
Mónica
M
Millán
Jordi
J
Fontcuberta
Josep-Lluis
JL
Martí-Vilalta
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D015415:Biomarkers; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator