Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction

Wang, R; Zeng, Jianxiong; Wang, F; Zhuang, Xinbo; Chen, X; Miao, Jiayin

doi:10.1093/qjmed/hcy292

Cited by 46 publications

(35 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…And we found that higher FIB may be associated with a higher incidence of HT among AIS patients, which is congruent with some reports [34,35]. However, Wang et al found that FIB < 1.50 g/L was a risk factor for HT [26]. We hypothesize that high levels of FIB may be associated with HT by participating in the in ammatory process.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies brie y mentioned the relationship between FIB and HT [26,34,35]. And we found that higher FIB may be associated with a higher incidence of HT among AIS patients, which is congruent with some reports [34,35].…”

Section: Discussionsupporting

confidence: 91%

“…According to clinical guidelines from the American Heart Association/American Stroke Association published in 2018, low PLT levels (< 100,000 counts/µl) would increase the risk of HT [25] and do not recommend these patients to receive reperfusion therapies. Several studies also pointed out that PLT was associated with the occurrence of HT [8,26]. Furthermore, a previous study identi ed that lower coated-platelets counts increased the likelihood of early HT in patients with nonlacunar ischemic stroke [27].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

Cheng

Chen

Zeng

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop to HT. In this study, we aimed to explore whether coagulation parameters are risk factors of HT in non-AF patients.Methods: We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 hours of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels.Results: In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268-9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455-0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346-2.760, P <0.001) were significantly associated with HT in non-AF patients. But in AF patients, coagulation parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032-1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047-1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients.Conclusions: Low PLT, low MPV and high FIB levels were independently associated with HT in non-AF patients. Additionaly, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that coagulation functions at admission may be beneficial for clinicians to recognize patients with high risk of HT at early stage and improve unfavorable long-term outcomes in non-AF patients.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

Cheng

Chen

Zeng

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Stroke-induced immunodepression syndrome (SIDS) is an immunological change in patients after stroke, and growing evidence has suggested that SIDS could protect our body from secondary inflammatory injury after stroke but would increase the susceptibility to SAP in AIS patients ( 42 , 43 ). When a stroke occurs, brain vessels would be blocked, which subsequently results in hypoxia, nutrient deficiency, and metabolic product accumulation in the infarction area.…”

Section: Discussionmentioning

confidence: 99%

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

et al. 2020

View full text Add to dashboard Cite

Purpose: Stroke-associated pneumonia (SAP), a common complication in acute ischemic stroke (AIS) patients, is associated with poor prognosis after AIS. Inflammation plays an important role in the development of SAP. In this study, we aimed to explore the association between the monocyte-to-lymphocyte ratio (MLR) and SAP in AIS patients. Methods: We continuously enrolled 972 AIS patients. SAP was diagnosed by two trained neurologists and confirmed by radiography, meeting the modified Centers for Disease Control and Prevention criteria. MLR values were measured for all participants, and all patients were evenly classified into three tertiles according to the MLR levels. We used the values that Youden's index max points corresponded to represent the optimal cutoffs, which represented the balance in sensitivity and specificity. Results: 104 (10.7%) patients were diagnosed with SAP. SAP patients showed a significant increased ( P < 0.001) MLR when compared with non-SAP. The optimal cutoff points of MLR were (T1) <0.2513, (T2) 0.2513–0.3843, and (T3) > 0.3843. The incidence of SAP was significantly higher in the third MLR tertile than the first and second MLR tertiles (21.7 vs. 4 vs. 6.5%, respectively, P < 0.001). After adjusting for confounding and risk factors, multivariate regression analysis showed that the third MLR tertile was an independent variable predicting the occurrence of SAP (odds ratio = 3.503, 95%CI = 1.066–11.515, P = 0.039). Conclusions: Our study showed that higher MLR was significantly associated with SAP in AIS patients. MLR is beneficial for clinicians to recognize patients with a high risk of SAP at an early stage and is an effective way to improve clinical care of SAP patients. Higher MLR could be a helpful and valid biomarker for predicting SAP in clinical practice.

show abstract

“…[1,2] Intravenous thrombolysis (IVT) is a proven effective therapy for patients suffering from AIS. [3] Studies showed that the time from onset to initiation of therapy is an important factor for good clinical outcome of IVT for AIS patients. [4,5] Recombinant tissue-type plasminogen activator (rt-PA) has a strong thrombolytic effect.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke

Chai¹,

Li²,

Jiang

2019

Medicine

View full text Add to dashboard Cite

This study was designed to investigate the factors affecting the in-hospital delay of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Two hundred and forty-eight consecutive AIS patients treated with intravenous administration of alteplase in Gansu Provincial Hospital from December 2014 to August 2018 were enrolled retrospectively in this study. According to door-to-needle (DTN) time, the patients were divided into either a delay group (DTN time > 60 minutes; n = 184) or a non-delay group (DTN time ≤60 minutes; n = 64). The baseline data, laboratory tests, onset-to-door (OTD) time, door-to-accepting time (DTA), door-to-imaging time (DTI), and decision-making time in both groups were recorded. Multivariate logistic analysis was performed to analyze the data. There were significant differences in previous history of cerebral ischemic attack, emergency system admission, education degree of decision makers, annual income, admission National Institutes of Health Stroke Scale (NIHSS), OTD time, DTA time, decision-making time between the 2 groups (all P < .05). Other baseline data and clinical features showed no significant difference between 2 groups ( P > .05). Multivariate logistic regression analysis revealed that the risk of in-hospital delay was lower for the higher NIHSS score (OR = 0.775, 95% CI: 0.644-0.933, P = .007), the longer OTD time (OR = 0.963, 95% CI: 0.937-0.991, P = .010), the shorter decision-making time (OR = 1.224, 95% CI: 1.004-1.492, P = .045). This study suggested that NIHSS score, OTD time and decision-making time are the independent factors affecting the in-hospital delay of IVT for AIS.

show abstract

Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction

Cited by 46 publications

References 17 publications

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke

Contact Info

Product

Resources

About