Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 2002 Apr 09;105(14):1679-85
Date
04/10/2002Pubmed ID
11940547DOI
10.1161/01.cir.0000012747.53592.6aScopus ID
2-s2.0-0037046216 (requires institutional sign-in at Scopus site) 395 CitationsAbstract
BACKGROUND: Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH.
METHODS AND RESULTS: In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH.
CONCLUSIONS: Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.
Author List
Tanne D, Kasner SE, Demchuk AM, Koren-Morag N, Hanson S, Grond M, Levine SRAuthors
Jeffrey R. Binder MD Professor in the Neurology department at Medical College of WisconsinDiane S. Book MD Associate Professor in the Neurology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute DiseaseAged
Biomarkers
Brain Ischemia
Canada
Cerebral Hemorrhage
Cohort Studies
Female
Germany
Humans
Injections, Intravenous
Logistic Models
Male
Middle Aged
Models, Cardiovascular
ROC Curve
Recombinant Proteins
Risk
Risk Assessment
Stroke
Survival Rate
Tissue Plasminogen Activator
Tomography, X-Ray Computed
United States