Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous thrombolysis

Wen, Lihong; Zhang, Song; Wan, Kunzhen; Zhang, Hong; Zhang, Xiaoyun

doi:10.1097/md.0000000000018995

Cited by 22 publications

(26 citation statements)

References 16 publications

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“…In addition, infarction evolution with HT can lead to significant neurological deterioration (17)(18)(19). The frequency of HT is associated with different factors, such as epidemiological factors (e.g., age, pre-stroke treatment, and conditions), characteristics of the infarct (size of ischemic core and timing of follow-up), reperfusion techniques in the acute phase (intravenous thrombolysis, mechanical thrombectomy, or combined), radiological diagnosis (CT or MRI techniques), and use of antithrombotics after the acute phase (20)(21)(22).…”

Section: Mildmass Effectmentioning

confidence: 99%

Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

Hong

Kim

2021

Front. Neurol.

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Symptomatic hemorrhagic transformation (HT) is one of the complications most likely to lead to death in patients with acute ischemic stroke. HT after acute ischemic stroke is diagnosed when certain areas of cerebral infarction appear as cerebral hemorrhage on radiological images. Its mechanisms are usually explained by disruption of the blood-brain barrier and reperfusion injury that causes leakage of peripheral blood cells. In ischemic infarction, HT may be a natural progression of acute ischemic stroke and can be facilitated or enhanced by reperfusion therapy. Therefore, to balance risks and benefits, HT occurrence in acute stroke settings is an important factor to be considered by physicians to determine whether recanalization therapy should be performed. This review aims to illustrate the pathophysiological mechanisms of HT, outline most HT-related factors after reperfusion therapy, and describe prevention strategies for the occurrence and enlargement of HT, such as blood pressure control. Finally, we propose a promising therapeutic approach based on biological research studies that would help clinicians treat such catastrophic complications.

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Section: Mildmass Effectmentioning

confidence: 99%

Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

Hong

Kim

2021

Front. Neurol.

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“…Chinese ethnicity was not associated with increased intracerebral hemorrhage, except for patients treated with IVT tPA only, with a prediction model from the logistic regression analysis, in association with age, international normalized value, and partial thromboplastin time ( 87 ). One meta-analysis evaluated all usual predictive markers of hemorrhagic transformation after IVT, specifically in the Chinese population ( 88 ). These markers were age, male sex, diabetes, atrial fibrillation (AF), previous stroke, onset-to-treatment time, NIHSS, infarct size, and ischemic signs of CT. A recent analysis of 1,324 genotypes of patients undergoing IVT led to the development of a clinical-genetic score using two genetic polymorphisms, which was validated on a MT cohort ( 66 ) in a Spanish population.…”

Section: Intracranial Bleeding After Reperfusion Therapy: Risk Factormentioning

confidence: 99%

“…Stroke etiology could play an important role in HT. AF has been described as being a risk factor for hemorrhagic transformation ( 88 , 93 , 94 ), possibly because of larger thrombi ( 3 ). Infective endocarditis is a cause of spontaneous hemorrhagic transformation ( 95 ) and a possible cause of hemorrhage after recanalization.…”

Section: Intracranial Bleeding After Reperfusion Therapy: Risk Factormentioning

confidence: 99%

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

et al. 2021

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Intracranial hemorrhage is one of the most feared complications following brain infarct. Ischemic tissues have a natural tendency to bleed. Moreover, the first recanalization trials using intravenous thrombolysis have shown an increase in mild to severe intracranial hemorrhage. Symptomatic intracerebral hemorrhage is strongly associated with poor outcomes and is an important factor in recanalization decisions. Stroke physicians have to weigh the potential benefit of recanalization therapies, first, with different risks of intracranial hemorrhage described in randomized controlled trials, and second with numerous risk markers that have been found to be associated with intracranial hemorrhage in retrospective series. These decisions have become quite complex with different intravenous thrombolytics and mechanical thrombectomy. This review aims to outline some elements of the pathophysiological mechanisms and classifications, describe most of the risk factors identified for each reperfusion therapy, and finally suggest future research directions that could help physicians dealing with these complications.

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“…In the report of Dang H et al, hemorrhagic transformation following the treatment was significantly higher in patients with AF undergoing IV thrombolysis, while no correlation was detected with prognosis [28]. Similarly, in a large-scale metanalysis study involving Chinese patients, Wen L., et al stated that hemorrhagic transformation was significantly higher in patients with AF who underwent IV thrombolysis [29]. In our study, there was no significant difference between symptomatic and asymptomatic intracerebral bleeding rates and functional results between the two groups.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of intravenous thrombolytic therapy in cardioembolic strokes

Çetiner¹,

Seyit²,

Eşkut³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: It is controversial whether intravenous recombinant tissue plasminogen activator (IV r-tPA) treatment outcomes in cardioembolic strokes differ from other types of strokes. This study aims to investigate the clinical data of patients with cardioembolic and large-vessel atherosclerosis who received IV r-tPA treatment and compare and discuss the results according to the literature. Methods: The data of the patients who were admitted within the first 4.5 hours following the onset of symptoms, diagnosed with acute ischemic stroke in the Neurology clinic of Kütahya Evliya Çelebi Training and Research Hospital and underwent IV r-tPA were evaluated in this retrospective cohort study. Demographic data, clinical and functional results of patients were compared between the two groups (cardioembolic and large vessel atherosclerosis). Results: Eighty-five patients with ischemic stroke who received IV r-tPA treatment due to cardioembolism and large-vessel atherosclerosis were included in the study. There were 51 patients (60%) in the cardioembolic stroke group and 34 patients (40%) in the large vascular atherosclerotic group. There was no significant difference in terms of functional results between the groups (62.7% vs 44.1%; P=0.09). While symptomatic intracerebral hemorrhage was not detected in the large-vessel atherosclerosis group, it occurred in 3.9% of the cardioembolic stroke group. Conclusion:This study proved that functional and clinical results are similar between cardioembolic and large-vessel atherosclerosis patients who were treated with IV r-tPA treatment. Regardless of the etiology, all suitable patients with acute ischemic stroke should be treated with thrombolytic therapy.

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Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous thrombolysis

Cited by 22 publications

References 16 publications

Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

Outcomes of intravenous thrombolytic therapy in cardioembolic strokes

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