title: The THRIVE score predicts symptomatic intracerebral hemorrhage after intravenous tPA administration in SITS-MOST.
abstract: BACKGROUND
  The Totaled Health Risks in Vascular Events (THRIVE) score is a clinical prediction score that predicts ischemic stroke outcomes in patients receiving intravenous tissue plasminogen activator, endovascular stroke treatment, or no acute therapy. We have previously found an association between THRIVE and risk of post-tissue plasminogen activator symptomatic intracranial hemorrhage in the National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator trial and risk of radiographic hemorrhage in Virtual International Stroke Trials Archive.
  
  
  OBJECTIVE
  The study aims to validate the relationship between THRIVE and symptomatic intracranial hemorrhage among tissue plasminogen activator-treated patients in the large Safe Implementation of Thrombolysis in Stroke - Monitoring Study (SITS-MOST).
  
  
  METHODS
  This is a retrospective analysis of the prospective SITS-MOST to examine the relationship between THRIVE and symptomatic intracranial hemorrhage after tissue plasminogen activator treatment. Symptomatic intracranial hemorrhage after tissue plasminogen activator was defined according to each of three standard definitions: the NINDS, European Cooperative Acute Stroke Study (ECASS), and Safe Implementation of Thrombolysis in Stroke (SITS) criteria. Multivariable logistic regression was used to confirm the relationship of THRIVE and individual THRIVE components with the risk of symptomatic intracranial hemorrhage and to examine the relationship of THRIVE, symptomatic intracranial hemorrhage, and functional outcome.
  
  
  RESULTS
  The odds ratio for symptomatic intracranial hemorrhage at each increased level of THRIVE score is 1·34 (95% CI 1·27 to 1·41, P < 0·001) for symptomatic intracranial hemorrhage by NINDS criteria, 1·36 (95% CI 1·27 to 1·46, P < 0·001) for symptomatic intracranial hemorrhage by ECASS criteria, and 1·21 (95% CI 1·09 to 1·36, P < 0·001) for symptomatic intracranial hemorrhage by SITS criteria. In receiver-operator characteristics analysis, the C-statistic for THRIVE prediction of symptomatic intracranial hemorrhage was 0·65 (95% CI 0·62 to 0·67) for symptomatic intracranial hemorrhage by NINDS criteria, 0·66 (95% CI 0·63 to 0·69) for symptomatic intracranial hemorrhage by ECASS criteria, and 0·61 (95% CI 0·56 to 0·66) for symptomatic intracranial hemorrhage by SITS criteria. Each component of the THRIVE score predicts the risk of symptomatic intracranial hemorrhage, with independent impact of each component in multivariable analysis.
  
  
  CONCLUSIONS
  The THRIVE score predicts the risk of symptomatic intracranial hemorrhage after intravenous tissue plasminogen activator administration. This external validation of the relationship between THRIVE and symptomatic intracranial hemorrhage in a prospective study further strengthens the role of the THRIVE score in the prediction of poststroke outcomes.
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Faigeles
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cullen
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.forename: Philip M
authors.initials: PM
authors.lastname: Bath
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
authors.forename: Geoff A
authors.initials: GA
authors.lastname: Donnan
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke therapy; cerebral infarction; intracerebral hemorrhage; ischemic stroke; rtPA; treatment