The prevalence and risk factors of hemorrhagic transformation (HT) after acute ischemic stroke HT have not been adequately delineated. We performed a systematic review and meta-analysis to identify English-language prospective observational MEDLINE and EMBASE-listed reports of acute ischemic stroke with HT published from 1985–2017. Studies that used the ECASS-2 definitions of hemorrhagic transformation subtypes, hemorrhagic infarction (HI), and parenchymal hematoma (PH) were included. Patients treated with intravenous thrombolysis with tissue plasminogen activator (IV-tPA) were compared with those who did not receive thrombolysis. A total of 65 studies with 17,259 patients met inclusion criteria. Overall, HT prevalence was 27%; 32% in patients receiving IV-tPA vs. 20% in those without. Overall PH prevalence was 9%; 12% in IV-tPA treated patients vs. 5% in those without. HT was associated with a history of atrial fibrillation (OR 2.94) and use of anticoagulants (OR 2.47). HT patients had higher NIHSS (Hedge’s-G 0.96) and larger infarct volume (diffusion-weighted MRI, Hedge’s-G 0.8). In IV-tPA treated patients, PH correlated with antiplatelet (OR 3) and statin treatment (OR 4). HT (OR 3) and PH (OR 8) were associated with a poor outcome at 90-day (mRS 5–6). Hemorrhagic transformation is a frequent complication of acute ischemic stroke and is associated with poor outcome. Recognition of risk factors for HT and PH may reduce their incidence and severity.

ObjectivesEpilepsy has been associated with cardiovascular comorbidity. This study aimed to assess the potential association between cardiovascular risk factors (CRFs), antiepileptic drugs (AEDs), and etiology.Material and MethodsA single‐center retrospective epilepsy cohort from the decade of 2004–2013 was assessed. Poisson regression models with robust variance were estimated to obtain CRF prevalence ratios (PR) according to AED prescription and etiology.ResultsAfter excluding patients in the monotherapy group with vascular etiology or previous cardiovascular events, in the remaining 400 patients, enzyme‐inducer AEDs (EIAEDs), especially phenytoin (PHT), were associated with higher prevalence of dyslipidemia (PRa 1.77, p < .05), compared to valproic acid. No etiology was associated with higher prevalence of any CRF.ConclusionsPatients treated with EIAEDs, especially PHT, had higher prevalence of dyslipidemia.

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Objective: Hemorrhagic transformation (HT) is common in patients with acute ischemic stroke and is associated with poor outcome. However, the accurate prevalence and risk factors for HT are uncertain. We aim to characterize rates, risk factors and prognosis of HT. Methods: We conducted a systematic review and meta-analysis of all published English literature of patients with acute ischemic stroke and HT. Medline and EMBASE were searched between 1985 and 2017, 2,099 relevant publications were identified. To obtain comparable data we included only studies that used the ECASS-2 definitions of Hemorrhagic Transformation and Parenchymal Hematoma (PH). Patients treated with intravenous thrombolysis (IV-tPA) were compared with those who did not receive thrombolysis. Results: Eligible studies (n=65) with 17,259 patients in total were included in this analysis. The overall prevalence of HT was 27% (95% CI 23-30); Patients not treated with IV-tPA had a prevalence of 20% (95% CI 14-27) vs. 32% (95% CI 27-37) in those treated. The overall prevalence of PH was 9% (95% CI 8-11); in untreated patients prevalence was 5% (95% CI 4-7) vs. 12% (95% CI 10-15) in the IV-tPA treated patients. The risk of HT was higher with: history of atrial fibrillation (OR 2.94, CI 2-4), use of anticoagulants (OR 2.47, 95% CI 1.6-4), higher NIHSS score (Hedge’s G 0.96, 95% CI 0.5-1.4), DWI infarct volume (Hedge’s G 0.8, 95% CI 0.01-1.5) and glucose level (Hedge’s G 0.4, CI 0.16-0.6). LDL was negatively correlated with HT (Hedge’s G -0.3, 95% CI -0.12- -0.48). Interactions were explored for factors associated with HT and thrombolysis treatment. In patients treated with IV-tPA, risk of PH was associated with antiplatelet use (OR 3, 95% CI 1-7), statin treatment (OR 4, 95% CI 1-9) and history of hypertension (OR 1.5, 95% CI 1.1-2). Poor 90-day outcome (mRS 5-6) was associated with HT (OR 3) and PH (OR 8). Conclusion: HT is common, even in patients not treated with IV-tPA, and tends to occur in patients with large and severe strokes. HT, and PH in particular, are associated with poor outcomes. Risk factors for HT should be identified to reduce burden of disability and future high quality . Prospective Longitudinal studies are warranted.