Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation.
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.
Lee
Ju-Hun
JH
Department of Neurology, Kang-Dong Sacred Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea.
Park
Kwang-Yeol
KY
Shin
Joon-Hyun
JH
Cha
Jae-Kwan
JK
Kim
Hahn-Young
HY
Kwon
Jee-Hyun
JH
Oh
Hyung Geun
HG
Lee
Kyung Bok
KB
Kim
Dong-Eog
DE
Ha
Sang-Won
SW
Cho
Kyung-Hee
KH
Sohn
Sung-Il
SI
Oh
Mi-Sun
MS
Yu
Kyung-Ho
KH
Lee
Byung-Chul
BC
Kwon
Sun U
SU
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
D000925:Anticoagulants