title: Clinical implication of hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator.
abstract: To determine the clinical implications of hemorrhagic transformation (HT) after thrombolysis, 241 eligible patients receiving alteplase for acute ischemic stroke were studied. HT was classified, according to the European Cooperative Acute Stroke Study criteria, as hemorrhagic infarction (HI) or parenchymal hemorrhage (PH). Symptomatic intracranial hemorrhage (SICH) was defined according to the National Institute of Neurological Disorders and Stroke study. A novel classification, clinically significant intracranial hemorrhage (CSICH) was defined as HTs associated with an unfavorable clinical outcome (modified Rankin Scale 5-6) at 3 months. For all subtypes of HT, we found that patients receiving alteplase were more often in the standard-dose group (0.90 ± 0.02 mg/kg) than in the lower dose group (0.72 ± 0.07 mg/kg). PH and SICH were related to an unfavorable clinical outcome, while HI was not. There was a positive trend between age and CSICH in patients receiving the standard dose (P = 0.0101), and between alteplase dose and CSICH in patients ≥70 years old (P = 0.0228). All PHs (including asymptomatic PHs) and symptomatic HIs have been found to be associated with unfavorable outcome, and for this reason defined as CSICH. Independent predictors of CSICH were age ≥70 years and the standard dose of alteplase. Further studies of thrombolysis for ischemic stroke with different doses of alteplase are warranted.
authors.affiliation: Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.|Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.|Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Bo-Lin
authors.initials: BL
authors.lastname: Ho
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.|Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.|Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ruey-Tay
authors.initials: RT
authors.lastname: Lin
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.|Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ching-Kuan
authors.initials: CK
authors.lastname: Liu
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan. achch@cc.kmu.edu.tw.|Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. achch@cc.kmu.edu.tw.
authors.forename: A-Ching
authors.initials: AC
authors.lastname: Chao
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; Hemorrhagic transformation; Intracranial hemorrhage; Thrombolysis; rt-PA