title: Symptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: a review of the risk factors.
abstract: BACKGROUND
  Symptomatic intracerebral hemorrhage (SICH) following thrombolytic therapy for acute ischemic stroke is associated with a high rate of morbidity and mortality. Knowledge of the risk factors associated with SICH following thrombolyitc therapy may provide insight into the pathophysiological mechanisms underlying the development of SICH, lead to the development of treatments that reduce the risk of SICH and have implications for the design of future stroke trials.
  
  
  METHODS
  Relevant studies were identified through a search in Pubmed. Included studies used multivariate analyses to identify independent risk factors for SICH following thrombolytic therapy. For each variable that was found to have a significant association with SICH, a secondary literature search was conducted to identify additional reports on the specific relationship between that variable and SICH.
  
  
  RESULTS
  Twelve studies met inclusion criteria for the systematic review. Extent of hypoattenuated brain parenchyma on pretreatment CT and elevated serum glucose or history of diabetes were independent risk factors for thrombolysis-associated SICH in six of the twelve studies. Symptom severity was an independent risk factor in three of the studies and advanced age, increased time to treatment, high systolic blood pressure, low platelets, history of congestive heart failure and low plasminogen activator inhibitor levels were found to be independent risk factors for SICH in a single study. Although these data should not alter the current guidelines for the use of rt-PA in acute stroke, they may help develop future strategies aimed at reducing the rate of thrombolysis-associated SICH.
authors.affiliation: Stanford University, Stanford Stroke Center, Palo Alto, CA 94304, USA. Lansberg@stanford.edu
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D001794:Blood Pressure; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D048909:Diabetes Complications / Q000139:chemically induced; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006333:Heart Failure; D006801:Humans; D016017:Odds Ratio; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010976:Platelet Count; D011859:Radiography; D011994:Recombinant Proteins / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D017395:Plasminogen Activator Inhibitor 1; D011994:Recombinant Proteins; C051321:SERPINE1 protein, human; D010959:Tissue Plasminogen Activator