Predictors of Hemorrhage Volume after Intravenous Thrombolysis

• Published in: Journal of stroke and cerebrovascular diseases 2016-10, Vol.25 (10), p.2543-2548
• Main Authors: Shon, Sang Hyun, MD, Heo, Sung Hyuk, MD, PhD, Kim, Bum Joon, MD, PhD, Choi, Hye-Yeon, MD, PhD, Kwon, Youngnam, MD, Yi, Sang Hun, MD, Lee, Ji Sung, PhD, Kim, Young Seo, MD, PhD, Kim, Hyun Young, MD, PhD, Koh, Seong-Ho, MD, PhD, Chang, Dae-Il, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - complications; Cardiovascular; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnostic imaging; cerebral infarction; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Humans; Infusions, Intravenous; Intracranial hemorrhage; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Neurology; Odds Ratio; patient outcome assessment; Recombinant Proteins - adverse effects; Registries; Republic of Korea; Retrospective Studies; Risk Factors; Stroke - diagnosis; Stroke - drug therapy; thrombolytic therapy; Thrombolytic Therapy - adverse effects; Time Factors; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.035

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.