Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis?
Current guidelines have contraindicated history of intracerebral hemorrhage for intravenous recombinant tissue plasminogen activator.



This study aimed to investigate the safety and effectiveness of intravenous recombinant tissue plasminogen activator for patients who had previous intracerebral hemorrhage on history or initial brain magnetic resonance imaging.



Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 4.5 h of onset. Previous intracerebral hemorrhage was defined as having a clinical history or evidence of old intracerebral hemorrhage on initial brain magnetic resonance imaging. Associations of previous intracerebral hemorrhage with symptomatic hemorrhagic transformation during hospitalization and functional outcome and mortality at discharge and three months were analyzed.



Among 1495 patients who were treated with intravenous recombinant tissue plasminogen activator, 73 (4.9%) had previous intracerebral hemorrhage; 9 on history only, 61 on magnetic resonance imaging only and 3 on both. Of those 1495 patients, 71 (4.7%) experienced symptomatic hemorrhagic transformation; 6.8% in patients with previous intracerebral hemorrhage and 4.6% in those without previous intracerebral hemorrhage. Multivariable logistic regression analysis showed that previous intracerebral hemorrhage did not significantly increase the risk of symptomatic hemorrhagic transformation (odds ratio 1.08, 95% confidence interval 0.39-2.96) mortality, and most of functional outcome measures



Previous intracerebral hemorrhage may neither increase the risk of symptomatic hemorrhagic transformation nor alter major clinical outcomes in acute ischemic stroke patients receiving intravenous recombinant tissue plasminogen activator. This study suggests reconsideration of prior history of intracerebral hemorrhage as an exclusion criterion for intravenous recombinant tissue plasminogen activator administration in acute ischemic stroke.
Department of Neurology, Graduate School, Kyung Hee University, Seoul, Korea.
Sang-Hwa
SH
Lee
Seoul National University Bundang Hospital, Seongnam, Korea.
Beom Joon
BJ
Kim
Seoul National University Bundang Hospital, Seongnam, Korea.
Moon-Ku
MK
Han
Seoul Medical Center, Seoul, Korea.
Tai Hwan
TH
Park
Soonchunhyang University Hospital, Seoul, Korea.
Kyung Bok
KB
Lee
Hallym University Sacred Heart Hospital, Anyang, Korea.
Byung-Chul
BC
Lee
Hallym University Sacred Heart Hospital, Anyang, Korea.
Kyung-Ho
KH
Yu
Hallym University Sacred Heart Hospital, Anyang, Korea.
Mi Sun
MS
Oh
Dong-A University Hospital, Pusan, Korea.
Jae Kwan
JK
Cha
Dong-A University Hospital, Pusan, Korea.
Dae-Hyun
DH
Kim
Dong-A University Hospital, Pusan, Korea.
Hyun-Wook
HW
Nah
Yeungnam University Medical Center, Daegu, Korea.
Jun
J
Lee
Eulji University School of Medicine, Eulji University Hospital, Daejeon, Korea.
Soo Joo
SJ
Lee
Eulji University School of Medicine, Eulji University Hospital, Daejeon, Korea.
Youngchai
Y
Ko
Eulji University School of Medicine, Eulji University Hospital, Daejeon, Korea.
Jae Guk
JG
Kim
Eulji General Hospital, Eulji University, Seoul, Korea.
Jong-Moo
JM
Park
Eulji General Hospital, Eulji University, Seoul, Korea.
Kyusik
K
Kang
Ilsan Paik Hospital, Inje University, Goyang, Korea.
Yong-Jin
YJ
Cho
Ilsan Paik Hospital, Inje University, Goyang, Korea.
Keun-Sik
KS
Hong
Jeju National University, Jeju, Korea.
Jay Chol
JC
Choi
Chonnam National University Hospital, Gwangju, Korea.
Joon-Tae
JT
Kim
Chonnam National University Hospital, Gwangju, Korea.
Kangho
K
Choi
Dongguk University Ilsan Hospital, Goyang, Korea.
Dong-Eog
DE
Kim
Dongguk University Ilsan Hospital, Goyang, Korea.
Wi-Sun
WS
Ryu
Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Wook-Joo
WJ
Kim
Chungbuk National University College of Medicine, Cheongju, Korea.
Dong-Ick
DI
Shin
Chungbuk National University College of Medicine, Cheongju, Korea.
Minju
M
Yeo
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Juneyoung
J
Lee
Clinical Research Center, Asan Medical Center, Seoul, Korea.
Ji Sung
JS
Lee
Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA.
Philip B
PB
Gorelick
Seoul National University Bundang Hospital, Seongnam, Korea braindoc@snu.ac.kr.
Hee-Joon
HJ
Bae
D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
Acute ischemic stroke; brain macrobleed; history of intracerebral hemorrhage; intravenous thrombolysis; mortality; symptomatic hemorrhagic transformation