title: Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score.
abstract: OBJECTIVE
  Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH.
  
  
  METHODS
  We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score.
  
  
  RESULTS
  We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70.
  
  
  CONCLUSIONS
  The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.
authors.affiliation: Department of Neurology, Karolinska University Hospital-Solna, Karolinska Stroke Research,Stockholm, Sweden. michael.mazya@karolinska.se
authors.forename: Michael
authors.initials: M
authors.lastname: Mazya
authors.forename: José A
authors.initials: JA
authors.lastname: Egido
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulik
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
mesh_terms: D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D001835:Body Weight; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000401:mortality; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality; D007275:Injections, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000401:mortality; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D010959:Tissue Plasminogen Activator; D013988:Ticlopidine; D001241:Aspirin