Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation.
OBJECTIVE
Reliable predictors of hemorrhagic transformation (HT) after stroke thrombolysis have not been identified. We analyzed hemorrhage in a randomized trial of tissue plasminogen activator (t-PA) vs placebo in ischemic stroke patients. We hypothesized that acute diffusion-weighted imaging (DWI) lesion volumes would be larger and blood pressures would be higher in patients with HT.


METHODS
HT was assessed 2 to 5 days after treatment in 97 patients. Hemorrhage was assessed by using susceptibility-weighted imaging sequences and was classified as petechial hemorrhagic infarction (HI) or parenchymal hematoma (PH).


RESULTS
PH was more frequent in t-PA- (11/49) than in placebo- (4/48) treated patients (P=0.049). Patients with PH had larger DWI lesion volumes (63.1+/-56.1 mL) than did those without HT (27.6+/-39.0 mL, P=0.033). There were no differences in baseline systolic blood pressure (SBP) between patients with and without hemorrhage. Weighted average SBP 24 hours after treatment was higher in patients with PH (159.4+/-18.8 mL, P<0.011) relative to those without HT (143.1+/-20.0 mL). Multinomial logistic regression indicated that PH was predicted by DWI lesion volume (odds ratio=1.16 per 10 mL; 95% CI, 1.03 to 1.30), atrial fibrillation (odds ratio=9.33; 95% CI, 2.30 to 37.94), and 24-hour weighted average SBP (odds ratio=1.59 per 10 mm Hg; 95% CI, 1.14 to 2.23).


CONCLUSIONS
Pretreatment DWI lesion volume and postthrombolysis BP are both predictive of HT. Consideration should be given to excluding patients with very large baseline DWI volumes from t-PA therapy and to more stringent BP control after stroke thrombolysis.
Butcher
Kenneth
K
2E3 WMC Health Sciences Centre, University of Alberta, 8440 112th St, Edmonton, Alberta, Canada T6G2B7. ken.butcher@ualberta.ca
Christensen
Søren
S
Parsons
Mark
M
De Silva
Deidre A
DA
Ebinger
Martin
M
Levi
Christopher
C
Jeerakathil
Thomas
T
Campbell
Bruce C V
BC
Barber
P Alan
PA
Bladin
Christopher
C
Fink
John
J
Tress
Brian
B
Donnan
Geoffrey A
GA
Davis
Stephen M
SM
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects
D010959:Tissue Plasminogen Activator