Cerebral Microbleeds are an Independent Predictor of Hemorrhagic Transformation Following Intravenous Alteplase Administration in Acute Ischemic Stroke

Nagaraja, Nandakumar; Tasneem, Nudrat; Shaban, Amir; Dandapat, Sudeepta; Ahmed, Uzair; Policeni, Bruno; Olalde, Heena; Shim, Hyungsub; Samaniego, Edgar A; Pieper, Connie; Leira, Enrique C.; Adams, Harold P.

doi:10.1016/j.jstrokecerebrovasdis.2017.12.044

Cited by 28 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, 282 studies were excluded because they were duplicates, 13,792 were excluded based on titles and abstracts, and 197 were excluded after a full-text reading revealed that the studies did not meet the inclusion criteria. Finally, for a total of 9,419 patients, 24 studies ( Derex et al, 2004 ; Kakuda et al, 2005 ; Zheng et al, 2012 ; Moriya et al, 2013 ; Dannenberg et al, 2014 ; Yan et al, 2014 , 2015a , b ; Curtze et al, 2015a , b ; Liu et al, 2017 , 2018 ; Huang, 2017 ; Xue et al, 2017 ; Chacon-Portillo et al, 2018 ; Nagaraja et al, 2018 ; Dong and Xia, 2018 ; Zhang and Zhang, 2018 ; Liu L. et al, 2019 ; Liu et al, 2019a ; Liu L. et al, 2019 ; Wen et al, 2019 ; Capuana et al, 2020 ; Zhuo et al, 2020 ) meeting the criteria were included. The selection process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Wang

Yan

Zhan

et al. 2021

Front. Aging Neurosci.

View full text Add to dashboard Cite

Objective: The aim of this study was to perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), and poor functional outcome (PFO).Methods: A thorough search of several databases was carried out to identify relevant studies up to December 2020. We included studies of patients with AIS and neuroimaging markers of CSVD treated with IVT. The primary outcome was HT, and the secondary outcomes were sICH and 3-month PFO. The quality of the studies involved was evaluated using the Newcastle–Ottawa Scale (NOS). The meta-analysis with the fixed effects model was performed.Results: Twenty-four eligible studies (n = 9,419) were pooled in the meta-analysis. All included studies were regarded as high quality with the NOS scores of at least 6 points. The meta-analysis revealed associations between the presence of CSVD and HT, sICH, and the 3-month PFO after IVT. Compared with no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52–2.16), sICH (OR: 2.42, 95% CI: 1.76–3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89–2.44). For patients with AIS complicated with CSVD, compared with a CSVD score of 0–1, a CSVD score of 2–4 was associated with an increased risk of HT (OR: 3.10, 95% CI: 1.67–5.77), sICH (OR: 2.86, 95% CI: 1.26–6.49), and 3-month PFO (OR: 4.58, 95% CI: 2.97–7.06).Conclusion: Patients with AIS complicated with neuroimaging markers of CSVD are at increased risk of HT and 3-month PFO after IVT. However, it is still necessary to clarify the exact role of CSVD in the occurrence, development, and prognosis of AIS.Systematic Review Registration:www.ClinicalTrials.gov, identifier CRD4202123 3900.

show abstract

Section: Resultsmentioning

confidence: 99%

Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Wang

Yan

Zhan

et al. 2021

Front. Aging Neurosci.

View full text Add to dashboard Cite

show abstract

“…However, currently, the best treatment for AIS is only reperfusion therapy, which includes intravenous tissue plasminogen activator (rt‐PA) and endovascular therapy (EVT; Brooks et al, ). Hemorrhagic transformation (HT) is the most serious complication for patients with AIS and can be induced by the natural evolution of AIS or by reperfusion therapy (Jickling et al, ; Nagaraja et al, ). Hemorrhagic transformation is classified as hemorrhagic infarction (HI) and parenchymatous hematoma (PH; von Kummer et al, ).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

Zhang

Xiao-dong

et al. 2019

Brain and Behavior

View full text Add to dashboard Cite

Introduction The neutrophil‐to‐lymphocyte ratio (NLR) has been shown to be a marker associated with inflammation and is independently associated with the adverse clinical outcomes of symptomatic intracranial hemorrhage, cancer, and cardiovascular disease. Hemorrhagic transformation (HT) is a serious complication of ischemic cerebral infarction and can be intensified by therapeutic interventions for acute ischemic stroke (AIS). The purpose of our research was to explore the predictive effect of NLR for HT in patients with AIS and to determine the best predictive value. Methods PubMed, Web of Science, EMBASE, MEDLINE, Cochrane, and Google Scholar were searched. The primary endpoint was HT, and subgroup analysis was performed. Review Manager software version 5.3 was used to statistically analyze the outcomes. Results A total of seven studies including 3,726 patients met the inclusion criteria. The pooled odds ratio (OR) value of the high NLR that predicted HT in AIS patients was 1.53 (95% CI, 1.21–1.92; p = .0003). In addition, 1.10 (95% CI, 1.05–1.15; p < .0001) was the pooled OR of the high NLR associated with increased 3‐month mortality in patients with AIS. In the subgroup analysis with an NLR cutoff value of 7.5–11, the correlation between NLR above the cutoff value and the rate of HT in patients with AIS was statistically significant (OR, 7.93; 95% CI, 2.25–27.95; p = .001). Conclusion A high NLR can predict HT and 3‐month mortality in patients with AIS. Regardless of the country of origin and the sampling time, an NLR with a cutoff value of 7.5–11 was independently associated with HT in AIS patients.

show abstract

“…Whilst studies [3] suggest that VKAs are independently associated with the development of new CMBs, similar generalizability cannot be conferred on DOACs. Interestingly, a recent study suggested that CMBs are an independent predictor of HT following IV thrombolytic therapy in acute ischaemic stroke [4]. This thought is particularly important in this study [1], especially considering that CMBs have not been shown to predict HT in the absence of IV thrombolysis [4].…”

mentioning

confidence: 86%

The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

Vilanilam

Badi

Vemireddy

et al. 2019

Euro J of Neurology

View full text Add to dashboard Cite

Cerebral Microbleeds are an Independent Predictor of Hemorrhagic Transformation Following Intravenous Alteplase Administration in Acute Ischemic Stroke

Cited by 28 publications

References 25 publications

Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

The role of anticoagulant therapy in hemorrhagic transformation of acute ischaemic stroke in nonvalvular atrial fibrillation patients

Contact Info

Product

Resources

About