Document Detail


Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation.
MedLine Citation:
PMID:  20714158     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF).
METHODS: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration.
RESULTS: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 10(4) increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055).
CONCLUSIONS: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.
Authors:
Ju-Hun Lee; Kwang-Yeol Park; Joon-Hyun Shin; Jae-Kwan Cha; Hahn-Young Kim; Jee-Hyun Kwon; Hyung Geun Oh; Kyung Bok Lee; Dong-Eog Kim; Sang-Won Ha; Kyung-Hee Cho; Sung-Il Sohn; Mi-Sun Oh; Kyung-Ho Yu; Byung-Chul Lee; Sun U Kwon
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-08-12
Journal Detail:
Title:  European neurology     Volume:  64     ISSN:  1421-9913     ISO Abbreviation:  Eur. Neurol.     Publication Date:  2010  
Date Detail:
Created Date:  2010-10-07     Completed Date:  2011-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0150760     Medline TA:  Eur Neurol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  193-200     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 S. Karger AG, Basel.
Affiliation:
Department of Neurology, Kang-Dong Sacred Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anticoagulants / therapeutic use
Atrial Fibrillation / complications*,  drug therapy,  etiology
Brain Ischemia / complications
Cerebral Hemorrhage / diagnosis*,  etiology*
Female
Humans
Incidence
Logistic Models
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Registries
Republic of Korea
Retrospective Studies
Stroke / complications*,  drug therapy,  etiology
Tomography, X-Ray Computed
Chemical
Reg. No./Substance:
0/Anticoagulants

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