Treatment and Outcome of Thrombolysis-Related Hemorrhage

Yaghi, Shadi; Boehme, Amelia K; Dibu, Jamil; Guerrero, Christopher R. Leon; Ali, Syed F.; Martin‐Schild, Sheryl; Sands, Kara; Noorian, Ali Reza; Blum, Christina; Chaudhary, Shuchi; Schwamm, Lee H; Liebeskind, David S; Marshall, Randolph S.; Willey, Joshua Z.

doi:10.1001/jamaneurol.2015.2371

Cited by 87 publications

(81 citation statements)

References 20 publications

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“…The most frequent time for tPA-related intracerebral hemorrhage is the first hours after onset of IV treatment and the average bleeding time was 470 minutes in one study (89). Only hemorrhage within the first 36 hours post-treatment can be associated with tPA (89).…”

Section: Question: What Should Be Done If Intracerebral Hemorrhage Ocmentioning

confidence: 87%

See 1 more Smart Citation

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2017

tnd

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162Use of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke.Keywords: Stroke, thrombectomy, contraindication, avoidance, training Akut iskemik inme tedavisinin kritik elementlerinin başında gelen intravenöz doku plazminojen aktivatörü (tPA) kullanımının yirmi yılı aşkın süre içinde ülkemizde yeterince yaygınlaşamamasının başta gelen nedenlerinden biri, kullanımına dair birçok sorunun yanıtsız kalmasıdır. Ancak, son gelişmeler ile bu soruların pek çoğuna yeterli açıklamanın getirilebilmiş olması önemli bir anlayış değişikliğine yol açmaktadır. Bu makalede akut inmede tPA tedavisi ile ilgili uzmanlarımızın yönelttiği birincil olarak nörolojik sorulara ilişkin yanıt ve açıklamalar mevcut literatür ışığında etraflıca ele alınmış ve herbiri için net tavsiyelerde bulunulmuştur.Anahtar Kelimeler: Strok, trombektomi, kontrendikasyon, kaçınma, eğitim Abstract Öz

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Section: Question: What Should Be Done If Intracerebral Hemorrhage Ocmentioning

confidence: 87%

“…The mortality of PH type 2 hematomas is more than 50% (92). Expansion and clinical deterioration in follow-up imaging modalities occur in approximately 50% of cases within the first 24 hours (89). For this reason, follow-up CT is performed with 4-6-hour intervals on the first day.…”

Section: Question: What Should Be Done If Intracerebral Hemorrhage Ocmentioning

confidence: 99%

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2017

tnd

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“…47 Hypofibrinogenemia (fibrinogen level <150 mg/dL) at the time of sICH diagnosis has also been associated with hematoma expansion. 48 The coagulopathy produced by alteplase is not the only determinant of hemorrhage occurring within an infarct (hemorrhagic infarct); it is also encountered even without the use of thrombolytic or anticoagulant agents. In a pooled analysis of thrombolytic clinical trials, radiographic evidence of hemorrhage occurred in 24.2% of placebo-treated patients and 32.5% of alteplase-treated patients 49 ; most of these hemorrhages were considered asymptomatic.…”

Section: Pathophysiology Of Alteplase-related Hemorrhagic Transformationmentioning

confidence: 99%

“…48,83,84 In 1 study of 128 alteplase-treated patients, nearly 80% of patients with sICH were diagnosed >2 hours after the alteplase infusion, and the median time from alteplase treatment to sICH diagnosis was nearly 8 hours. 48 Therefore, treating practitioners may consider extending the period of intensive (every 30 minutes) neurological and cardiovascular monitoring to 12 hours from the currently recommended 8 hours, particularly in patients with high risk for developing sICH. Larger prospective studies are needed to confirm the cost-effectiveness of this monitoring strategy.…”

Section: Timing Of Postthrombolytic Ichmentioning

confidence: 99%

“…A recent multicenter retrospective study showed that patients diagnosed with sICH within the first 3 hours after alteplase infusion had significantly lower mean admission NIHSS scores than those diagnosed after 3 hours (median score, 11 versus 17; P=0.01). 48 This likely reflects characteristics of the NIHSS score, with a "ceiling effect" such that at the upper range new neurological injury may not change the score. A lower clinical threshold to trigger urgent repeat imaging or even earlier routine brain imaging may be warranted in patients with severe ischemic strokes; this might allow earlier diagnosis and treatment.…”

Section: Detecting Sichmentioning

confidence: 99%

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Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Yaghi¹,

Willey²,

Cucchiara³

et al. 2017

Stroke

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387

307

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Purpose— Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. Methods— A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. Results— sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes.

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THRIVE‐c score predicts clinical outcomes in Chinese patients after thrombolysis

et al. 2018

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ObjectivesTotal Health Risks in Vascular Events‐calculation score (THRIVE‐c) is an easy use and patient‐specific outcome predictive score by computing the logistic equation with patients’ continuous variables. We validated its performance in Chinese ischemic stroke patients receiving intravenous thrombolysis (IVT) therapy.Materials and MethodsWe used data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS‐China) registry to validate the THRIVE‐c score in patients receiving IVT therapy. We evaluated the score performance using area under the receiver operating characteristic curve (AUC). Receiver operator characteristic curve (ROC) was used to compare THRIVE‐c score performance with other scores in predicting clinical outcome and symptomatic intracranial hemorrhage (SICH). Calibration was assessed by Pearson correlation coefficient and Hosmer–Lemeshow test.ResultsAmong the 1,128 patients receiving IVT therapy included in this study, AUC of the THRIVE‐c score for 3‐month SICH, poor functional outcome, and mortality rate was 0.70 (95% CI: 0.63–0.76), 0.75 (95% CI: 0.73–0.78) and 0.81 (95% CI: 0.77–0.85), respectively. The increased THRIVE‐c score was associated with higher risk of developing SICH, poor functional outcome, or mortality in patients with acute ischemic stroke at 3 months after thrombolysis. The performance of the THRIVE‐c score was similar to or superior to other predictive scores (THRIVE score, SEDAN score, DRAGON score, HIAT2 score).ConclusionsThe THRIVE‐c score reliably predicts the risks of 3‐month SICH, poor functional outcome, and mortality after IVT therapy in Chinese patients with ischemic stroke.

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Treatment and Outcome of Thrombolysis-Related Hemorrhage

Cited by 87 publications

References 20 publications

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

THRIVE‐c score predicts clinical outcomes in Chinese patients after thrombolysis

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