title: Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis.
abstract: BACKGROUND
  Symptomatic intracranial hemorrhage (sICH) is a serious complication of IV rt-PA therapy after acute ischemic stroke. Independent sICH predictors have been previously derived using case-control studies. Here we utilized a novel cohort-based comparison to identify additional independent predictors of sICH.
  
  
  METHODS
  We included 210 patients receiving IV rt-PA therapy from January 2009 through December 2013 at the Yale-New Haven Stroke Center. Clinical parameters were compared using Mann-Whitney tests, two-sample tests of proportions and two-sample t tests. Logistic regression was performed using sICH as the dependent variable. Predictive ability was assessed using areas under the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  sICH rates were lowest from 2010 to 2012 and comprised the low sICH cohort (2.0 % sICH), compared to the high sICH cohort from 2009 to 2013 (9.2 % sICH, P = 0.025). Patients in the low sICH cohort had significantly more visual field deficits (38.6 vs. 24.8 %, P = 0.03) and decreased levels of consciousness (62.4 vs. 39.4 %, P < 0.001), but fewer hyperdense MCA signs (5 vs. 13.8 %, P = 0.03) and early CT hypodensities (14.9 vs. 29.4 %, P = 0.01). These four parameters together predicted sICH modestly (area under ROC curve 0.66, odds ratio 2.72, P = 0.03) CONCLUSIONS: Using a novel cohort-based approach, we identified two new independent predictors of sICH after IV rt-PA therapy: the presence of the hyperdense MCA sign and early CT hypodensities. Novel methods are needed to reduce the risk of sICH for patients receiving antithrombolytic therapy for ischemic stroke.
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA. david.asuzu@yale.edu.
authors.forename: David
authors.initials: D
authors.lastname: Asuzu
authors.affiliation: Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Nyström
authors.affiliation: Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Hardik
authors.initials: H
authors.lastname: Amin
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA.|Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA.|Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Wira
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA.|Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: David
authors.initials: D
authors.lastname: Greer
authors.affiliation: Department of Neurology, Taipei Medical University Hospital and Shuang Ho Hospital, Taipei, Taiwan.
authors.forename: Nai Fang
authors.initials: NF
authors.lastname: Chi
authors.affiliation: Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Halliday
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA. kevin.sheth@yale.edu.|Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA. kevin.sheth@yale.edu.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: IV Thrombolysis; Intracerebral hemorrhage; Neurocritical care