Article Details


Prognostic Parameters for Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in an Asian Population

[ Vol. 14 , Issue. 2 ]

Author(s):

Thanin Lokeskrawee, Sombat Muengtaweepongsa, Jayanton Patumanond, Somsak Tiamkao, Thanoot Thamangraksat, Phanyarat Phankhian, Polchai Pleumpanupatand, Paworamon Sribussara, Teeraparp Kitjavijit, Anake Supap, Weerawan Rattanaphibool and Jariya Prisiri   Pages 169 - 176 ( 8 )

Abstract:


Background: Symptomatic intracranial hemorrhage (sICH) is a major complication after intravenous thrombolysis leading to severe disability and death. The incidence was higher in Asian than in western countries. Prognostic factors across ethnicities are presumably different. Studies in Asian populations are limited.

Method: Clinical data from January 2008 to September 2016 in one provincial and four regional hospitals in the northern part of Thailand were retrospectively reviewed. Patients were those with acute ischemic stroke, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed. They were classified into 3 groups; no intracranial hemorrhage (no ICH), asymptomatic intracranial hemorrhage (asICH) and symptomatic intracranial hemorrhage (sICH), based on clinical and brain imaging (computed tomography or CT). Prognostic parameters were investigated using a multi-level, multivariable ordinal logistic model.

Results: After exclusion of ineligible patients, the remaining 1,172 patients were classified into no ICH (n=923, 78.8%), asICH (n=154, 13.1%) and sICH (n=95, 8.1%). Independent prognostic parameters for intracranial hemorrhage were the National Institutes of Health Stroke Scale (NIHSS) >20 (OR, 3.51; 95% CI, 2.18-5.65; p<0.001), NIHSS >10 (OR, 2.02; 95% CI, 1.42-2.87; p<0.001), use of nicardipine during rt-PA (OR, 1.61; 95% CI, 1.09-2.40; p=0.018), systolic blood pressure (SBP) prior to thrombolysis ≥ 140 mmHg (OR, 1.47; 95% CI, 1.06-2.04; p=0.021), and platelet count <250,000 cell/mm3 (OR, 1.45; 95% CI, 1.04-2.01; p=0.029).

Conclusion: Patients with these parameters should be closely monitored. Information should be provided to the patients and their relatives.

Keywords:

Stroke, thrombolytic therapy, tissue plasminogen activator, intracranial hemorrhages, prognosis, risk factors.

Affiliation:

Department of Emergency Medicine, Lampang Hospital, Lampang, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat Univerisity, Pathum Thani 12120, Department of Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Thammasat University, Pathum Thani, Division of Neurology, Department of Internal Medicine, Khon Kaen University, Khon Kaen, Division of Neurology, Department of Internal Medicine, Chiang Rai Hospital, Chiang Rai, Division of Neurology, Department of Internal Medicine, Uttaradit Hospital, Uttaradit, Division of Neurology, Department of Internal Medicine, Buddhachinaraj Hospital, Phitsanulok, Division of Neurology, Department of Internal Medicine, Buddhachinaraj Hospital, Phitsanulok, Division of Neurology, Department of Internal Medicine, Buddhachinaraj Hospital, Phitsanulok, Department of Emergency Medicine, Buddhachinaraj Hospital, Phitsanulok, Department of Emergency Medicine, Buddhachinaraj Hospital, Phitsanulok, Division of Neurology, Department of Internal Medicine, Nan Hospital, Nan



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