title: Predictors of Hemorrhage Volume after Intravenous Thrombolysis.
abstract: BACKGROUND
  Symptomatic intracerebral hemorrhage (sICH) is one of the most feared complications after administration of intravenous recombinant tissue plasminogen activator (IV rtPA). The aim of this study was to determine correlations between hemorrhage volume (HV) after IV rtPA treatment and risk factors for sICH.
  
  
  METHODS
  We analyzed 318 patients from the stroke registries of 4 hospitals in Korea. We confirmed hemorrhage by computed tomography (CT) or magnetic resonance imaging within 36 hours. Patient groups were classified by HV (0, 0-10, 10-25, and greater than 25 mL). Based on the HV, we evaluated the following: (1) predictors for hemorrhage; (2) rates of sICH according to various sICH definitions; and (3) 3-month functional outcomes after IV rtPA treatment.
  
  
  RESULTS
  Among the 318 patients, hemorrhage occurred in 72 patients. HV was significantly correlated with atrial fibrillation (OR = 3.38, 95% CI = 1.87-6.09), early CT changes (OR = 3.17, 95% CI = 1.69-5.93), and dense artery sign (OR = 1.90, 95% CI = 1.07-3.39). Compared with the groups with HV less than 25 mL, patients with an HV of greater than 25 mL were more likely to have higher mortality rates (33.3% versus 11.8%) and worse outcomes at 3 months (good: 8.3% versus 50.3%; excellent: 0% versus 33.7%).
  
  
  CONCLUSIONS
  HV after IV rtPA is an important predictor of clinical outcomes. Atrial fibrillation, early CT changes, and dense artery sign were significantly associated with large HVs; therefore, these patient factors might be considered before and after thrombolytic treatment.
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Shon
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea. Electronic address: shheo73@khu.ac.kr.
authors.forename: Sung Hyuk
authors.initials: SH
authors.lastname: Heo
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Bum Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Hye-Yeon
authors.initials: HY
authors.lastname: Choi
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Youngnam
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Yi
authors.affiliation: Clinical Research Center, Asan Medical Center, Seoul, South Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Young Seo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Neurology, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Koh
authors.affiliation: Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
authors.forename: Dae-Il
authors.initials: DI
authors.lastname: Chang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011994:Recombinant Proteins / Q000009:adverse effects; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: Intracranial hemorrhage; cerebral infarction; patient outcome assessment; thrombolytic therapy