Risk Factors for Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Cerebral Infarction: A Retrospective Single-Center Study

• Published in: World neurosurgery 2017-05, Vol.101, p.155-160
• Main Authors: Xu, Xiahong, Li, Changsong, Wan, Ting, Gu, Xiaobo, Zhu, Wenxia, Hao, Junjie, Bao, Huan, Zuo, Lian, Hu, Hui, Li, Gang
• Format: Article
• Language: English
• Subjects: Acute cerebral infarction; Acute Disease; Administration, Intravenous; Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnostic imaging; Cerebral Infarction - surgery; Female; Fibrinolytic Agents - adverse effects; Hemorrhagic transformation; Humans; Magnetic Resonance Imaging; Male; Middle Aged; r-tPA; Regression Analysis; Retrospective Studies; Risk Factors; Thrombolysis; Tissue Plasminogen Activator - adverse effects; Tomography Scanners, X-Ray Computed
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.01.091

To investigate the risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute cerebral infarction. Patients with acute cerebral infarction receiving r-tPA thrombolysis in Shanghai Eastern Hospital were retrospectively studied. Based on the cranial computed tomography or magnetic resonance imaging examination, after the intravenous thrombolysis, the patients were divided into 2 groups: an HT group and a non-HT group. The information was collected before or after thrombolysis. RESULTS: A total of 162 patients were included in the analysis. The age ranged from 25 to 86 years, with an average age of 65.6 ± 10.6 years. The average time from disease onset to thrombolysis was 188 ± 53.1 minutes. Cranial computed tomography or magnetic resonance imaging showed that 20 patients (12.3%) had HT after thrombolysis. Using univariate analysis, history of atrial fibrillation, positive expression of urinary protein, and high National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, we found that there was a significant difference between the HT and non-HT group (P < 0.05) in the level of mean systolic pressure (MSP) 24 hours after thrombolysis. Multivariate logistic regression analysis indicated that age ≥80 years, MSP ≥140 mm Hg, NIHSS score, and fibrinogen concentration before thrombolysis were risk factors for HT after thrombolysis in patients with acute cerebral infarction. Age, MSP, NIHSS score, and fibrinogen concentration before thrombolysis are risk factors for HT after thrombolysis in acute cerebral infarction. These 4 factors should be carefully taken into account before thrombolysis.