title: Thrombolysis risk prediction: applying the SITS-SICH and SEDAN scores in South African patients.
abstract: At present, the only specific medical treatment for acute ischaemic stroke is intravenous administration of recombinant tissue plasminogen activator within 4.5 hours of stroke onset. In the last year, two scores for risk stratification of intracranial haemorrhage have been derived from multicentric European trial groups, the Safe Implementation of Treatment in Stroke - Symptomatic IntraCerebral Haemorrhage risk score (SITS-SICH) and the SEDAN score. The aim of this study was to pilot their use in a cohort of patients treated at a South African tertiary hospital. Prospectively collected data were used from a cohort of 41 patients who underwent thrombolysis at Groote Schuur Hospital from 2000 to 2012. Computerised tomography brain imaging was available for review in 23 of these cases. The SITS-SICH and SEDAN scores were then applied and risk prediction was compared with outcomes. Two patients suffered symptomatic intracranial haemorrhage (SICH), representing 4.9% (95% CI: 0-11.5%) of the cohort. This was comparable to the SICH rate in both the SITS-SICH (5.1%) and SEDAN (6.5%) cohorts. Patient scores in the Groote Schuur Hospital cohort appeared similar to those of the validation cohorts of both SITS-SICH and SEDAN. With increasing use of thrombolysis in a resource-constrained setting, these scores represent a potentially useful tool in patient selection of those most likely to benefit from intravenous thrombolysis, reducing risk for SICH and with the added benefit of curtailing cost.
authors: Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa. alex.v.klemp@gmail.com.
authors: A
authors: A
authors: von Klemperer
authors: Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa.
authors: K
authors: K
authors: Bateman
authors: Department of Radiology, Groote Schuur Hospital and University of Cape Town, South Africa.
authors: J
authors: J
authors: Owen
authors: Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa.
authors: A
authors: A
authors: Bryer
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D013019:South Africa; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D010959:Tissue Plasminogen Activator; D013988:Ticlopidine; D001241:Aspirin
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