Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke

Abstract

BackgroundGlycated hemoglobin (HbA1c) is a commonly used indicator of glycemic control in diabetes mellitus. Uncontrolled diabetes can lead to cardiovascular complications. Ischemic strokes are often complicated by hemorrhagic transformation, which is the conversion of an infarcted area into an area of hemorrhage. The purpose of this study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke. MethodsThis is a prospective, single-center cohort study of patients admitted to the Neurology and Medicine wards between June 1 and November 30, 2019. Inclusion criteria included adult patients who were admitted with acute ischemic stroke and had been tested for HbA1c on presentation. There were 110 ischemic stroke patients enrolled in our database. An HbA1c level >53 mmol/mol was considered raised. A comparison was done between the group with raised HbA1c levels and the group with target levels of HbA1c for the occurrence of hemorrhagic transformation. Brain imaging was used to diagnose hemorrhagic transformation. ResultsOut of 110 study participants with ischemic stroke, 70 (63.6%) patients had a history of prior known diabetes. The mean HbA1c levels were 7.44 ± 1.79%. A total of 77% of diabetic patients had raised HbA1c levels (>7%). Hemorrhagic transformation was seen in 21 (19.1%) patients, of whom only 38% (n=8) had raised HbA1c levels. The association between raised HbA1c and hemorrhagic transformation was not found to be statistically significant (p = 0.225). ConclusionIn this study of patients with ischemic stroke, raised HbA1c levels were not found to be associated with hemorrhagic transformation. There is a need for larger scale studies to find out the cause and mechanism of hemorrhagic transformation in ischemic stroke.

Early Hemorrhagic Transformation after Reperfusion Therapy in Patients with Acute Ischemic Stroke: Analysis of Risk Factors and Predictors

“…The incidence of HT after reperfusion is 10 times higher compared to the incidence after spontaneous reperfusion [18] and is increased with time (the later the reperfusion, the higher the HT rate) [19], age [20], stroke severity (assessed with the National Institutes of Health Stroke Scale (NIHSS)) [20], high systolic blood pressure, acute high glucose level, antiplatelet or dual antiplatelet usage before, obesity [21], lower platelet count and by the presence of other comorbidities (atrial fibrillation, hypertension, and diabetes mellitus) [22][23][24]. Therefore, it is critical to investigate how to predict HT in patients with acute ischemic stroke before reperfusion therapy.…”