| Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation. | |
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MedLine Citation:
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PMID: 19926841 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Reliable predictors of hemorrhagic transformation (HT) after stroke thrombolysis have not been identified. We analyzed hemorrhage in a randomized trial of tissue plasminogen activator (t-PA) vs placebo in ischemic stroke patients. We hypothesized that acute diffusion-weighted imaging (DWI) lesion volumes would be larger and blood pressures would be higher in patients with HT. METHODS: HT was assessed 2 to 5 days after treatment in 97 patients. Hemorrhage was assessed by using susceptibility-weighted imaging sequences and was classified as petechial hemorrhagic infarction (HI) or parenchymal hematoma (PH). RESULTS: PH was more frequent in t-PA- (11/49) than in placebo- (4/48) treated patients (P=0.049). Patients with PH had larger DWI lesion volumes (63.1+/-56.1 mL) than did those without HT (27.6+/-39.0 mL, P=0.033). There were no differences in baseline systolic blood pressure (SBP) between patients with and without hemorrhage. Weighted average SBP 24 hours after treatment was higher in patients with PH (159.4+/-18.8 mL, P<0.011) relative to those without HT (143.1+/-20.0 mL). Multinomial logistic regression indicated that PH was predicted by DWI lesion volume (odds ratio=1.16 per 10 mL; 95% CI, 1.03 to 1.30), atrial fibrillation (odds ratio=9.33; 95% CI, 2.30 to 37.94), and 24-hour weighted average SBP (odds ratio=1.59 per 10 mm Hg; 95% CI, 1.14 to 2.23). CONCLUSIONS: Pretreatment DWI lesion volume and postthrombolysis BP are both predictive of HT. Consideration should be given to excluding patients with very large baseline DWI volumes from t-PA therapy and to more stringent BP control after stroke thrombolysis. |
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Authors:
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Kenneth Butcher; Søren Christensen; Mark Parsons; Deidre A De Silva; Martin Ebinger; Christopher Levi; Thomas Jeerakathil; Bruce C V Campbell; P Alan Barber; Christopher Bladin; John Fink; Brian Tress; Geoffrey A Donnan; Stephen M Davis; |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2009-11-19 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-29 Completed Date: 2010-01-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 72-7 Citation Subset: IM |
Affiliation:
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2E3 WMC Health Sciences Centre, University of Alberta, 8440 112th St, Edmonton, Alberta, Canada T6G2B7. ken.butcher@ualberta.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Blood Pressure* / physiology Cerebral Hemorrhage / etiology*, pathology Female Humans Hypertension / complications Male Middle Aged Thrombolytic Therapy / adverse effects* Time Factors Tissue Plasminogen Activator / administration & dosage, adverse effects |
| Chemical | |
Reg. No./Substance:
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EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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