Journal of Neurological Sciences (Turkish) Ahead Of Print
Identifying Risk Factors for rt-PA-related Intracerebral Hemorrhages in Patients with Acute Stroke
ezgi sezer eryıldız1, atilla özcan özdemir1, demet funda baş1, fezan şahin mutlu2
1Eskisehir Osmangazi University, Medical Faculty, Neurology, Eskişehir,
2Eskisehir Osmangazi University, Medical Faculty, Biostatistics, Eskişehir,
DOI : 10.24165/jns.10056.17 Background and Purpose. To evaluate risk factors for intracerebral hemorrhages and the clinical effects of these hemorrhages in patients treated with recombinant tissue plasminogen activator (rt-PA) for acute stroke. Methods. In this prospective analysis, data were collected for patients with acute anterior circulation stroke who received intravenous (IV) rt-PA within 4.5 hours of symptom onset, after computed tomography (CT) between December 2008 and July 2013. Copies of head CT scans were obtained 24 hours after starting treatment. Intracerebral hemorrhages were classified according to the European-Australasian Acute Stroke Study (ECASS) classification. The definition of Safe Implementation of Thrombolysis in Stroke (SITS) was used for symptomatic intracerebral hemorrhage (sICH). The clinical outcomes of the patients were determined using the modified Rankin scale (mRS) at 90 days after treatment. Results. Asymptomatic intracerebral hemorrhage (aICH) was observed in 50 (22.6%) of 221 patients and symptomatic intracerebral hemorrhage (sICH) was observed in 9 (4.1%). Multivariate analysis showed that the baseline glucose level and Alberta Stroke Program Early CT (ASPECT) score were associated with sICH. However, only the baseline ASPECT score was related to aICH. Patients with sICH and aICH both had higher mRS scores and mortality rates at 90 days compared with those without. Conclusions. The presence of early ischemic changes on CT and hyperglycemia at the time of admission are independent risk factors for sICH in patients treated with IV rt-PA. Therefore, care must be taken in the evaluation and management of these factors. Keywords : acute stroke, thrombolysis, rt-PA, intracerebral hemorrhage.