title: Glycosylated hemoglobin A1 predicts risk for symptomatic hemorrhage after thrombolysis for acute stroke.
abstract: OBJECTIVE
  Symptomatic intracerebral hemorrhage (sICH) is the most feared acute complication after intravenous thrombolysis. The aim of this study was to determine the predictive value of parameters of glycosylated hemoglobin A1 (HbA1c) on sICH.
  
  
  METHODS
  In a retrospective single center series, 1112 consecutive patients treated with thrombolysis were studied. Baseline blood glucose was obtained at admission. HbA1c was determined within hospital stay. A second head computed tomography was obtained after 24 hours or when neurological worsening occurred. Modified Rankin Scale was used to assess outcome at 90 days.
  
  
  RESULTS
  A total of 222 patients (19.9%) had any hemorrhage; 43 of those had sICH (3.9%) per Safe Implementation of Treatments in Stroke definition and 95 (8.5%) per National Institute of Neurological Disorders and Stroke definition; 33.2% of patients had a dependent outcome (modified Rankin Scale score 3-5). In univariate analysis history of diabetes mellitus, HbA1c, blood glucose, and National Institute of Health Stroke Scale score on admission were associated with any hemorrhage and sICH. In multivariate analysis National Institute of Health Stroke Scale score, a history of diabetes mellitus, and HbA1c were predictors of sICH per National Institute of Neurological Disorders and Stroke, and only HbA1c when Safe Implementation of Treatments in Stroke criteria were used.
  
  
  CONCLUSIONS
  In our study, HbA1c turns out to be an important predictor of sICH after thrombolysis for acute stroke. These results suggest that hemorrhage after thrombolysis may be a consequence of long-term vascular injury rather than of acute hyperglycemia, and that HbA1c may be a better predictor than acute blood glucose or a history of diabetes mellitus.
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany. andrea.rocco@med.uni-heidelberg.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocco
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Diedler
authors.forename: Marek
authors.initials: M
authors.lastname: Sykora
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Eric
authors.initials: E
authors.lastname: Jüttler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006442:Glycated Hemoglobin; D010959:Tissue Plasminogen Activator
keywords: acute stroke; blood glucose; glycosylated hemoglobin; outcome; symptomatic hemorrhage; thrombolytic therapy; tissue plasminogen activator