Haemorrhagic transformation following ischaemic stroke: A retrospective study

Abstract

The aim of this study was to identify the prevalence of haemorrhagic transformation (HT) in patients with ischaemic stroke, and evaluate its association with medical comorbidities, stroke subtypes, premorbid medication, and long-term survival. To achieve this, we performed a retrospective analysis of 527 consecutive stroke rehabilitation patients. Of these, 102 (19.4%) developed HT. Older patients, and those with large artery strokes, had a higher risk of HT. Forty-one patients received alteplase (rtPA), of which 15 (36.6%) developed HT. A total of 129 (24.5%) patients were taking aspirin prior to their stroke and, of these, 39 (30.2%) developed HT. Twenty-three (4.36%) patients were taking vitamin k antagonists, prior to stroke, of which 14 (60.9%) developed HT. There were 102 patients (19.35%) with underlying atrial fibrillation, of whom 55 (53.9%) developed HT. Patients with known ischaemic heart disease had an increased risk of HT, and patients with HT had significantly lower total cholesterol levels (4.96 vs. 5.34) and lower LDL cholesterol levels (3.20 vs. 3.5). In conclusion, older age, atrial fibrillation, treatment with oral anticoagulants and antiplatelet medications prior to stroke, low total and LDL cholesterol, and rtPA use, are all associated with HT. Survival was not affected by the presence of HT.

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

“…This is supported by the fact that a BBB disruption measured in the first hours of stroke does not predict the appearance of HT occurring later than 3 days ( 129 ). It is thought that late HT occurs due to increased BBB permeability and blood flow after cerebral edema reduction ( 130 , 131 ). The hemorrhage appearance differs according to the stage it occurs.…”

“…Of the patients presenting with HT in the acute phase, 25% have had received reperfusion therapy, while only 16.7% of the late HT patients did ( 131 ). In another cohort of 527 patients, 86.3% of patients with HT developed it in the first 48 h ( 130 ). Montaner et al showed that 68.75% of patients with HT presented it in the first 48 h. Interestingly, seven of the 11 patients developing HT in the first 48 h had recanalization in the first 12 h, while none of the patients with HT beyond 48 h had early recanalization ( 110 ).…”

Sterile Leukocytosis Predicts Hemorrhagic Transformation in Arterial Ischemic Stroke: A National Inpatient Sample Study

“…Despite HT is a serious complication commonly following reperfusion therapy and, sometimes as a result of the natural evolution of the disease [13], the current treatment recommendations include anticoagulants, thrombolysis, and intravascular procedures [14]. Thus, available and routine clinical prediction tools of HT based on pathophysiological mechanisms are necessary to decide the best management options according to the patient's system response to stroke.…”

Effect of Possible Osteoporosis on Parenchymal-Type Hemorrhagic Transformation in Patients with Cardioembolic Stroke

“…HT is divided into hemorrhagic infarction (HI) and parenchymal hematoma (PH) types [ 2 ]. Patients with HI-type HT have no significantly higher risk of neurological deterioration than patients without HT, but patients with PH-type HT have symptomatic clinical deterioration [ 1 , 2 , 3 , 4 ]. According to a previous study, only PH-type HT in ischemic stroke is associated with early or late symptomatic neurological deterioration; we therefore wanted to focus on the risk factors associated with the occurrence of PH-type HT [ 4 ].…”