title: Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation.
abstract: OBJECTIVE
  Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF).
  
  
  METHODS
  Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration.
  
  
  RESULTS
  Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 10(4) increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055).
  
  
  CONCLUSIONS
  Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.
authors: Department of Neurology, Kang-Dong Sacred Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea.
authors: Ju-Hun
authors: JH
authors: Lee
authors: Kwang-Yeol
authors: KY
authors: Park
authors: Joon-Hyun
authors: JH
authors: Shin
authors: Jae-Kwan
authors: JK
authors: Cha
authors: Hahn-Young
authors: HY
authors: Kim
authors: Jee-Hyun
authors: JH
authors: Kwon
authors: Hyung Geun
authors: HG
authors: Oh
authors: Kyung Bok
authors: KB
authors: Lee
authors: Dong-Eog
authors: DE
authors: Kim
authors: Sang-Won
authors: SW
authors: Ha
authors: Kyung-Hee
authors: KH
authors: Cho
authors: Sung-Il
authors: SI
authors: Sohn
authors: Mi-Sun
authors: MS
authors: Oh
authors: Kyung-Ho
authors: KH
authors: Yu
authors: Byung-Chul
authors: BC
authors: Lee
authors: Sun U
authors: SU
authors: Kwon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants