Early computed tomography signs as early predictors of hemorrhagic transformation under heparinization in patients with cardiogenic embolism.
OBJECTIVE
Early computed tomography (CT) signs are crucial to predict the onset of hemorrhagic transformation (HT) and are preventive to avoid a fatal hematoma after thrombolysis. In the present study, we retrospectively reviewed the clinical records of patients receiving heparinization to investigate the correlation between early CT signs and the frequency of HT.


METHODS
We reviewed 96 patients with cardiogenic cerebral embolism. These patients were admitted within 24 h of the onset and were subsequently given 5000-15,000 units of heparin per day for 3 days. Owing to CT on admission, early CT changes were evaluated. Patient characteristics were also estimated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease and history of smoking. The probability of hemorrhagic transformation, or good outcome and independence was assessed by backward stepwise logistic regression analysis based on the maximum likelihood ratio.


RESULTS
Higher baseline National Institutes of Health Stroke Scale (NIHSS) score, early CT signs and absence of hyperlipidemia diversely correlated with the occurrence of HT. Also, the presence or absence of early CT signs was significantly related to HT classification (χ(2)-test; P < 0.05). It was statistically significant that a higher baseline NIHSS score (OR 8.51; 95% CI 3.11-27.75) affected the outcome without showing a significant relationship to early CT signs.


CONCLUSIONS
Presence of early CT signs correlated more strongly with HT than with the interval from symptom onset to hospital arrival. We might extend the therapeutic time for thrombolytic therapy, only if the early CT sign does not appear.
Department of Neurosurgery, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan. takeshitera@aol.com
Takeshi
T
Terao
Masahiro
M
Mishina
Ichiro
I
Takumi
Yuichi
Y
Komaba
Takayuki
T
Mizunari
Shiro
S
Kobayashi
Daizo
D
Yoshida
Akira
A
Teramoto
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D006493:Heparin