Document Detail

Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey.
MedLine Citation:
PMID:  11940547     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH. METHODS AND RESULTS: In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH. CONCLUSIONS: Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.
David Tanne; Scott E Kasner; Andrew M Demchuk; Nira Koren-Morag; Sandra Hanson; Martin Grond; Steven R Levine
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  105     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-04-09     Completed Date:  2002-04-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1679-85     Citation Subset:  AIM; IM    
Stroke Unit, Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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MeSH Terms
Acute Disease
Biological Markers / blood*
Brain Ischemia / blood*,  complications,  diagnosis
Cerebral Hemorrhage / diagnosis,  etiology,  prevention & control*
Cohort Studies
Injections, Intravenous
Logistic Models
Middle Aged
Models, Cardiovascular
ROC Curve
Recombinant Proteins / administration & dosage,  adverse effects
Risk Assessment
Stroke / blood*,  complications,  diagnosis
Survival Rate
Tissue Plasminogen Activator / administration & dosage,  adverse effects*
Tomography, X-Ray Computed
United States
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/Recombinant Proteins; EC Plasminogen Activator
Comment In:
Circulation. 2002 Apr 9;105(14):e9094-5   [PMID:  11940564 ]

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