Predictors of symptomatic intracranial haemorrhage in patients with an ischaemic stroke with neurological deterioration after intravenous thrombolysis

Abstract

Change in level of consciousness is associated with sICH among patients undergoing emergent brain imaging after receiving tPA. In this group of patients, preparation of tPA reversal agents while awaiting brain imaging may reduce reversal times. Future studies are needed to study the cost-effectiveness of this approach.

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

“…This frequency and proportion of END was comparable to previous studies in which 0.9 mg/kg alteplase was administrated [1, 2, 7, 9, 13, . The median time from administration of rt-PA to deterioration was 8 h for END h and 4 h for END i , and mainly occurred within first 2 h. Similar results were reported in a recent study in which END occurred at a mean of 7.3 h after rt-PA administration in patients with sICH, and 4.8 h in those without [15]. Moreover, ERIS has been reported to occur during or shortly after rt-PA administration [5,6].…”

“…Univariate analyses of clinical characteristics between non-END patients and patients with END h and END i are shown in Table 1. Compared with non-END patients, the extensive EIC and large artery occlusions were more common in patients with both END subtypes; the pretreatment NIHSS score was higher (20.5 [16][17][18][19][20][21][22][23][24][25][26] vs. 14 [8][9][10][11][12][13][14][15][16][17][18][19][20], p = 0.001) and pretreatment with antiplatelets was more common (50.0% vs. 27.7%, p = 0.022) in patients with END h , and AF was more common in patients with END i (64.9% vs. 49.3%, p = 0.027). The multivariate analyses revealed that a higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END h .…”

“…Other reported cases exhibit unexplained neurological deterioration; this is presumably caused by an infarct growth beyond the initial penumbra, which is often referred to as 'stroke progression' [7][8][9]. Previous studies have demonstrated that several clinical and radiological factors on admission and/or at 24 h were associated with END [1,[9][10][11][12][13][14][15]. While the detailed cause for deterioration has rarely been identified, there might be differences between the risk factors for END due to ischemic insults and those for END due to hemorrhagic insults.…”

Diagnosis and management of acute ischaemic stroke

“…Most deterioration related to intracerebral haemorrhage occurred after the complete rtPA infusion, and deterioration was four times more likely to be due to initial ischaemia rather than to intracerebral haemorrhage. 65 Deteriorating patients need urgent repeat neuroimaging to clarify the cause and rtPA infusion is usually suspended pending imaging.…”

The risk of symptomatic intracranial hemorrhage after thrombolysis for acute stroke: Current concepts and perspectives

“…From a prospective stroke database, the only predictor of SICH was the change in the level of consciousness, which happened in 108 out of 511 patients and 19 of them had SICH (odds ratio [OR]: 6.62; 1.64–26.7). [30]…”