Clinical predictors of hemorrhagic transformation after thrombolytic therapy an Egyptian center experience

Abstract

Background: thrombolysis is the only approved pharmacological treatment for acute stroke. It acts as a mediator of recanalization and sometimes causes secondary hemorrhage depending on the size of the ischemic lesion, little is known about the efficacy and hemorrhagic complication of thrombolytic therapy, we aim to identify clinical predictors of hemorrhagic transformation. Methods: a cross-sectional comparative study in Sohag University Hospital for 1226 acute ischemic stroke patient admitted to our department from 1 st April 2019 till 31 st March 2020, of the 21 patients treated with thrombolytic therapy further subdivided into two groups; (Group A): patients who didn't complicate with hemorrhagic transformation and (group B) patients who developed hemorrhagic transformation after receiving intravenous thrombolysis, the correlation between hemorrhagic transformation and clinical characteristic, vascular risk factors, and demographic data is done. Results: We found a small percentage (1.7%) of acute ischemic stroke patients receiving thrombolytic therapy. Old age, ischemic heart disease, high admission NIHSS on admission, and NIHSS 24h after admission are associated with hemorrhagic transformation with p-value (0.024), (0.048), (0.085), and (0.001) respectively. Patients treated with thrombolytic therapy have statistically significant improvement in NIHSS 24h after admission in comparison to the admission NIHSS with a p-value (< 0.001). Conclusion: Elderly, high NIHSS on admission, and tachycardia are associated with hemorrhagic transformation following treatment with IV thrombolytic therapy, Despite the updated management of acute ischemic stroke only a small percentage (1.7%) of acute ischemic stroke patients receiving thrombolytic therapy, this in need of further investigations.