Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models

Nisar, Taha; Hanumanthu, Rajanigandhi; Khandelwal, Priyank

doi:10.1016/j.jstrokecerebrovasdis.2019.104360

Cited by 25 publications

(23 citation statements)

References 34 publications

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“…Analogous to END, predictors of sICH have been widely reported, including but not limited to higher NIHSS on presentation, older age, history of hypertension, and hyperglycemia [ 19 – 21 ]. Because of our small proportion of patients suffering from sICH, predictors could not be determined; however, for patients that had any ICH, we found similar findings: older age, more severe baseline NIHSS, and higher presentation glucose levels.…”

Section: Discussionmentioning

confidence: 99%

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

et al. 2021

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Background Acute ischemic stroke (AIS) is a major contributor toward healthcare-associated costs and services. Symptomatic intracranial hemorrhage (sICH) and early neurologic decline (END), defined as a National Health Institute Stroke Scale score decline of ≥ 4 within 24 h (with or without sICH), remain major concerns when administering intravenous tissue plasminogen activator (IV tPA) despite improved functional neurologic outcomes with its use. Given these risks, current guidelines recommend comprehensive stroke care (most often in an intensive care unit setting) for 24 h posttreatment. However, a number of patients may remain stable after IV tPA and thus not require such intensive resources. We sought to determine causes of END, along with timing and predictors of both sICH and END, to identify patients at lower risk of neurological deterioration and those suitable for earlier transition to a lower level of care. Methods This present study analyzed patients with AIS that presented within 4.5 h of being last seen well and received IV tPA. Baseline demographic, clinical, and radiographic findings were collected. Outcomes included END from any cause, parenchymal hemorrhage (PH1 or PH2), sICH, and mortality at 90 days. Results A total of 1238 patients with AIS without acute treatment of large vessel occlusion received IV tPA. 9.4% (116) had presence of any degree of ICH on noncontrast computed tomography head and 7.4% (91) experienced associated END. 2.7% (33) of patients experienced sICH, while 6.7% (83) experienced asymptomatic ICH. Of the patients with END, 63.7% did not have ICH. Predictive factors at presentation for END included an older age (72.6 ± 16.1 vs. 69.1 ± 14.8, p = 0.03), history of tobacco use (odds ratio [OR] 2.1 [1.1–4.3], p = 0.04), and hyperlipidemia (OR 1.7 [1.1–2.8], p = 0.02), along with the presence of an untreated large vessel occlusion (OR 2.1 [1.4–3.1], p = 0.02). Most END occurred within a mean time of 242 ± 251 min (4 ± 4 h). Because of the small proportion of patients suffering from sICH (33), predictors could not be determined; however, for patients with any ICH, predictive factors included an older age (74.6 ± 12.4 vs. 68.8 ± 15.1, p = 0.001), higher baseline National Health Institute Stroke Scale score (14.6 ± 7.3 vs. 10.8 ± 7.9, p = 0.002), and higher baseline glucose levels (155.1 ± 87.5 vs. 140.4 ± 70.5, p = 0.04). Conclusions In this study, only a small proportion suffered from either sICH and/or END, typically within 12 h of tPA administration. These findings may support earlier deescalation of higher acuity monitoring in clinically stable post-IV tPA patients without large vessel occlusion.

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Section: Discussionmentioning

confidence: 99%

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

et al. 2021

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“…If the prediction is correct, b and b ∧ are equal, that is, the weights will not be updated, and the model is stable. Otherwise, the weights are continuously updated [19]. e perceptron can easily implement the linear model, but it cannot be implemented for the nonlinear model, because the perceptron is only processed by one layer of activation function [20].…”

Section: Multilayer Neural Network Structurementioning

confidence: 99%

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

Jiang

Zuo

Chen

et al. 2022

Emergency Medicine International

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With the popularization of intravenous thrombolysis, more and more people use intravenous thrombolysis to treat related diseases, but problems also arise. There are still a considerable number of patients with early disease after thrombolytic therapy not only not significantly improving, but also progressing, that is, early neurological deterioration (END). In view of this problem, the prediction of END after intravenous thrombolysis becomes very important. With the development of medical technology, research on the prediction of END after intravenous thrombolysis has gradually been carried out. Effective prediction is of great significance for the prevention and treatment of END after intravenous thrombolysis. This article aimed to carry out a meta-analysis of the predictive role of END after intravenous thrombolysis. Through an informed analysis of all studies of this type in this field, this article determines a method for predicting END after intravenous thrombolysis. The actual effect of its role is revealed in this paper, and its purpose is to promote the development of this field. This article addresses the same type of study on the predictive role of neurological deterioration after intravenous thrombolysis. The article performs test and meta-analysis of its role by conditionally searching for literature studies. It is explained using the relevant theoretical formulas. The analysis results show that the prediction of END after intravenous thrombolysis in this paper can effectively help make a preliminary judgment on the possible later neurological deterioration. Although there is an error between the predicted curve and the actual curve, the difference between the two is between 1% and 5%. It can basically effectively predict the occurrence of END. Therefore, the prediction of END after intravenous thrombolysis has a very large preventive effect on the END after intravenous thrombolysis.

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“…Significant differences, however, were noted for serum glucose at admission, history of diabetes mellitus and systolic blood pressure, which were higher or more frequent, respectively, in RSI+ patients. Hyperglycaemia and high blood pressure are associated with an increased of haemorrhagic transformation after IVT [25][26][27][28][29]. According to this, the risk of haemorrhagic transformation should have been higher in the RSI+ cohort.…”

Section: Resultsmentioning

confidence: 99%

Recent silent infarcts do not increase the risk of haemorrhage after intravenous thrombolysis

Stösser

Ullrich

Kassubek

et al. 2020

Euro J of Neurology

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Background and purpose Haemorrhagic transformation (HT) is one of the main risks of intravenous thrombolysis (IVT) for acute ischaemic stroke. Contraindications serve to exclude patients at high risk of HT after IVT. One of these contraindications is a stroke within the preceding 3 months. It is unclear if this contraindication should include recent clinically silent infarcts (RSIs). The aim of this study was to investigate whether RSIs are associated with a higher risk of HT and a worse clinical outcome after IVT for acute ischaemic stroke. Methods In a retrospective monocentric cohort study, all patients who received IVT for acute ischaemic stroke based on magnetic resonance imaging were assessed over 5 years. RSIs were defined as lesions with diffusion restriction and positive signal on fluid attenuated inversion recovery sequences. Patients with RSIs (RSI+) were compared to patients without RSIs (RSI−) regarding HT after IVT and clinical outcome. Results In all, 981 patients who had received IVT for acute ischaemic stroke demonstrated by magnetic resonance imaging were identified. RSIs were detected in 115 patients (11.5%). HT after IVT was observed in 32 (28.3%) RSI+ and 56 (25.8%) RSI− patients (P = 0.624). Symptomatic intracerebral haemorrhage was noted in two (1.8%) RSI+ and five (2.3%) RSI− patients (P = 1.000). No differences in clinical outcome were observed. Conclusions The detection of RSIs in patients treated with IVT for acute ischaemic stroke was not associated with a higher risk of HT or a worse clinical outcome. The results of this study argue against considering RSIs as a contraindication for IVT.

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Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models

Cited by 25 publications

References 34 publications

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

Recent silent infarcts do not increase the risk of haemorrhage after intravenous thrombolysis

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