title: Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction.
abstract: BACKGROUND
  Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA).
  
  
  METHODS
  We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition.
  
  
  RESULTS
  Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P=.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P=.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P=.221) or any HT (18% versus 14%; P=.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P<.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P=.065).
  
  
  CONCLUSIONS
  Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham Veterans Administration Medical Center, Birmingham, Alabama. Electronic address: mjlyerly@uab.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Houston
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), Birmingham, Alabama; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED), Minority Health & Health Disparities Research Center (MHRC), Birmingham, Alabama.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Reza
authors.initials: R
authors.lastname: Bavarsad Shahripour
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Paola
authors.initials: P
authors.lastname: Palazzo
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Alvi
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Pawan V
authors.initials: PV
authors.lastname: Rawal
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Niren
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: April
authors.initials: A
authors.lastname: Sisson
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; computerized tomography; safety; symptomatic intracerebral hemorrhage; thrombolysis