title: A Four-Year Experience of Symptomatic Intracranial Hemorrhage Following Intravenous Tissue Plasminogen Activator at a Comprehensive Stroke Center.
abstract: BACKGROUND
  To describe the 4-year experience of symptomatic intracranial hemorrhage (sICH) rate at a high-volume comprehensive stroke center.
  
  
  METHODS
  All admitted adult (≥18 years) patients presenting with an ischemic stroke from 2010 to 2013 were included in this study. The primary outcome was sICH, defined as any hemorrhage with neurological deterioration (change in National Institutes of Health Stroke Scale score ≥4) within 36 hours of intravenous tissue plasminogen activator (IV-tPA) treatment, or any hemorrhage resulting in death. Secondary outcomes were in-hospital mortality and having a favorable modified Rankin Scale (mRS) score (≤2).
  
  
  RESULTS
  A total of 1925 did not receive intravascular (IV) or intra-arterial (IA) therapy; only 451 received IV therapy; and 175 received both IV and IA therapies. In IV-only patients, the overall rate of sICH was 2.2%; in IV and IA patients, the rate was 5.7%; and in patients who received no therapy, the rate was .4%. The IV-only group had an sICH rate of .9% in 2013. There were no differences in the adjusted odds of dying in the hospital between the study groups. IV-only treatment offered significantly better odds of achieving a favorable functional outcome, compared to no therapy, among patients with moderate stroke severity, whereas IV and IA treatments offered significantly better odds among patients with severe strokes. The odds of achieving a favorable functional outcome by discharge were decreased by 97% if patients suffered an sICH (OR = .03, 95%CI = .004, .19).
  
  
  CONCLUSIONS
  Despite an increased risk of sICH with IV-tPA, treatment with IV-tPA continues to be associated with increased odds of a favorable discharge mRS.
authors: Swedish Medical Center, Englewood, Colorado.
authors: Alessandro
authors: A
authors: Orlando
authors: Swedish Medical Center, Englewood, Colorado.
authors: Jeffrey C
authors: JC
authors: Wagner
authors: Swedish Medical Center, Englewood, Colorado.
authors: Christopher V
authors: CV
authors: Fanale
authors: Swedish Medical Center, Englewood, Colorado.
authors: Michelle
authors: M
authors: Whaley
authors: Swedish Medical Center, Englewood, Colorado.
authors: Kathryn L
authors: KL
authors: McCarthy
authors: Swedish Medical Center, Englewood, Colorado. Electronic address: dbaror@ampiopharma.com.
authors: David
authors: D
authors: Bar-Or
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000401:mortality; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Tissue plasminogen activator; ischemic stroke; modified Rankin Scale score; symptomatic intracranial hemorrhage