Document Detail


Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation.
MedLine Citation:
PMID:  19926841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-11-19
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-29     Completed Date:  2010-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  72-7     Citation Subset:  IM    
Affiliation:
2E3 WMC Health Sciences Centre, University of Alberta, 8440 112th St, Edmonton, Alberta, Canada T6G2B7. ken.butcher@ualberta.ca
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MeSH Terms
Descriptor/Qualifier:
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:
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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