Predictors of intracerebral hemorrhage in acute stroke patients receiving intravenous recombinant tissue plasminogen activator

Abstract

Background:Symptomatic Intracerebral hemorrhage (sICH) is a serious complication of recombinant tissue-plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS).Objective:To estimate the prevalence and predictors of sICH in patients after receiving IV rt-PA for AIS.Material and Methods:Consecutive patients of AIS thrombolysed between January 2010 and June 2016 in a University hospital in Hyderabad (India) were studied prospectively for sICH and it's various variables compared with the control group without sICH to determine any sigificantant difference.Results:Out of 113 patients , sICH was detected in 12 (10.61%) whose mean age(58±12.0 years) and gender ratio ( 2:1 ) was not statistically significant from controls. In s ICH group mean NIHSS score was 16.53± 5.81 vs 10.19± 5.06 in controls (p<0.001), gap between stroke onset and thrombolysis was 227.50±46.15 min vs 178.50± 69.20 min in controls(p=0.018). At presentation mean blood sugar was 208.75±90.97 mg/dl in sICH group vs 146.83±70.21 mg/dl in controls (p=0.002). Prior diabetes was in 7(53.30%) vs 23 (22.8%) in controls (p= 0.014)and hypertension in 11 (91.7%) vs (56(55.4%) in controls (p= 0.026) The mortality in sICH was 7 (58.30%)vs 4 (4.94%) in controls (p<.0.001). At 3 months mean mRS ofsICH patients was 5.57± 0.54 vs 2.17± 1.69 in controls (p<.05).Conclusion:High NIHSS score, increased stroke onset to thrombolysis time , high blood sugar at presentation ,prior diabetes and hypertension increase the chances of sICH. None of these contraindicate thrombolysing strokes but should caution the physician.

Blood glucose level affects prognosis of patients who received intravenous thrombolysis after acute ischemic stroke? A meta-analysis

“…The increased risk of sICH after intravenous thrombolysis in high glucose level group compared with non-high glucose level points to an effect of blood glucose levels on the risk of sICH. Previous studies have also shown that admission blood glucose is one of the predictors of sICH (22)(23)(24), even after controlling for HbA1c (25). Possible mechanisms include higher blood glucose impairing cellular metabolism, reducing vascular reactivity, increasing blood-brain barrier permeability and exacerbating acidosis in reperfused brain tissue.…”

Retrospective Evaluation of the Results of Low-Dose Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

“…Although not a contraindication for thrombolytic therapy, prolonged symptom/needle time, high baseline NIHSS score, hypertension, and diabetes history have been shown to be the most significant predictors of the risk for thrombolysis-related symptomatic ICH. [ 31 ] atrial fibrillation and cardioembolic strokes have been linked to increased risk and poor prognosis of thrombolysis-related ICH. [ 32 - 34 ] In our study, the presence of diabetes among the vascular risk factors of the two groups was remarkably higher in the standard-dose IV r-tPA group.…”

Impact of Hospital Level on Stroke Outcomes in the Thrombolytic Therapy Era in Northeast Thailand: A Retrospective Study

“…These findings may be explained by the higher proportion of patients with small vessel disease in CHs than in the other two hospital levels, 43.8% vs. 35.6% vs. 31.5%, as shown in Table 1 . As a result, the CH group had lower initial NIHSS than the others, leading to higher odds of intracerebral hemorrhage [ 12 ]. Patients with acute ischemic stroke with higher initial NIHSS had higher odds of symptomatic intracerebral hemorrhage than those with lower NIHSS (16.53 vs. 10.19; p < 0.001).…”