Prediction of Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke: The Symptomatic Intracranial Hemorrhage Score

Lokeskrawee, Thanin; Muengtaweepongsa, Sombat; Patumanond, Jayanton; Tiamkao, Somsak; Thamangraksat, Thanoot; Phankhian, Phanyarat; Pleumpanupat, Polchai; Sribussara, Paworamon; Kitjavijit, Teeraparp; Supap, Anake; Rattanaphibool, Weerawan; Prisiri, Jariya

doi:10.1016/j.jstrokecerebrovasdis.2017.06.030

Cited by 29 publications

(40 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study identified some distinct factors that were predictive for END subtypes; severe stroke symptoms and pretreatment with antiplatelets were associated with END h , and extensive EIC and large artery occlusions were associated with END i . Similar to previous studies [21][22][23], a higher pretreatment NIHSS score was associated with END h . In the Japan Alteplase Clinical Trial [24], 5 of 6 patients who developed sICH had a pretreatment NIHSS score of ≥ 19.…”

Section: Discussionsupporting

confidence: 89%

“…Univariate analyses of clinical characteristics between non-END patients and patients with END h and END i are shown in Table 1. Compared with non-END patients, the extensive EIC and large artery occlusions were more common in patients with both END subtypes; the pretreatment NIHSS score was higher (20.5 [16][17][18][19][20][21][22][23][24][25][26] vs. 14 [8][9][10][11][12][13][14][15][16][17][18][19][20], p = 0.001) and pretreatment with antiplatelets was more common (50.0% vs. 27.7%, p = 0.022) in patients with END h , and AF was more common in patients with END i (64.9% vs. 49.3%, p = 0.027). The multivariate analyses revealed that a higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END h .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Tanaka

Matsumoto

Furuta

et al. 2019

J Thromb Thrombolysis

View full text Add to dashboard Cite

Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END h) or ischemic (END i) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END h and END i were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END h (3.0%) and 57 END i (7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END h. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36-5.64) and large artery occlusions (OR 3.09, 95% CI 1.53-6.57) were associated with END i. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Tanaka

Matsumoto

Furuta

et al. 2019

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke [1]. The rate of HT ranges from 7.5% to 49.5% [2][3][4][5], whereas the incidence of symptomatic HT ranges from 0.6% to 20% [6], depending on whether reperfusion therapy is performed. HT, especially symptomatic HT, is associated with poor prognosis and possibly influences the clinical decisionmaking on usage of thrombolytic and anticoagulant agents [7].…”

Section: Introductionmentioning

confidence: 99%

The association between monocyte to high-density lipoprotein ratio and hemorrhagic transformation in patients with acute ischemic stroke

Wang

Cheng

Song

et al. 2020

Aging

View full text Add to dashboard Cite

Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. We investigated whether the monocyte to high-density lipoprotein ratio (MHR) is related to HT. Consecutive patients with ischemic stroke within 24 h of symptom onset were included in this study. HT was diagnosed by follow-up brain imaging after admission, and was classified as asymptomatic or symptomatic according to whether patients showed any neurologic worsening. Logistic regression was performed to estimate the association between MHR and HT. Of the 974 enrolled patients, 148 (15.2%) developed HT, and 24 (2.5%) patients experienced symptomatic HT. Compared to the highest MHR tertile (> 0.37), the lowest MHR tertile (< 0.22) was associated with 1.81-fold increase (95% CI 1.08-3.01, P = 0.024) in the odds of HT and 3.82-fold increase (95% CI 1.04-14.00, P = 0.043) in the odds of symptomatic HT after adjustment for possible confounders. Using a multivariate logistic regression model with restricted cubic spline, we found that elevated MHR was associated with a decreased risk of HT and symptomatic HT. In summary, lower MHR was independently associated with increased risk of HT and symptomatic HT in patients with ischemic stroke.

show abstract

“…Early ischemic signs on CT or even hyperdense cerebral artery signs are difficult to interpret and require experienced personnel or experts to evaluate, as reported by Thanin et al [16]. Therefore, some scoring systems, including the MSS score [7], Safe Implementation of Thrombolysis in Stroke 8 (SITS)-SICH score [17], Glucose Race Age Sex Pressure Stroke Severity (GRASPS) score [4] and Stroke Prognostication using Age and National Institutes of Health (NIH) Stroke Scale (SPAN-100) positive index [18], have no CT component in their scoring systems.…”

Section: Discussionmentioning

confidence: 99%

A nomogram by adding atrial fibrillation to multicenter stroke survey score to predict intracranial hemorrhage in stroke patients undergoing thrombolysis

Miao

Yin

Liang

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Identiﬁcation of stroke patients at risk of postthrombolysis intracranial hemorrhage (ICH) in the clinical setting is essential. However, studies in this area spare.We aimed to develop a nomogram by adding atrial fibrillation to the Multicenter Stroke Survey (MSS) score to predict the probability of ICH in acute ischemic stroke patients undergoing thrombolysis. Methods: A retrospective observational study was conducted with 287 participants from a single center (67.2% males, median age 65 years). Head computed tomography scan was performed after 24 hour to evaluate ICH occurrence, and a computed tomography scan was done immediately in case of clinical worsening. The risk factors associated with ICH were analysed. Based on multivariate logistic model, a nomogram was generated for ICH on the basis of atrial fibrillation and the MSS score. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using calibration plot. Results: A total of 41(14.3%) ICH events occurred.The MSS score and atrial fibrillation were independent predictors of ICH in multivariate logistic regression analysis. Discrimination of the nomogram was superior to the MSS score alone (0.794 vs 0.741; P=0.034). The model was internally validated by using bootstrap (1000 samples) with AUC-ROC of 0.795. The calibration plot showed good agreement. Conclusion: We developed and internally validated a new nomogram using the MSS score and atrial fibrillation as predictors.The nomogram is a simple and accurate tool for predicting ICH in acute ischemic stroke patients undergoing thrombolysis. Further studies are warranted to validate our findings.

show abstract

Prediction of Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke: The Symptomatic Intracranial Hemorrhage Score

Cited by 29 publications

References 18 publications

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

The association between monocyte to high-density lipoprotein ratio and hemorrhagic transformation in patients with acute ischemic stroke

A nomogram by adding atrial fibrillation to multicenter stroke survey score to predict intracranial hemorrhage in stroke patients undergoing thrombolysis

Contact Info

Product

Resources

About