BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rtPA) is an effective treatment for acute ischemic stroke but is associated with an increased risk of intracranial hemorrhage (ICH). We sought to identify the risk factors for ICH with a systematic review of the published literature. METHODS: We searched for studies of rtPA-treated stroke patients that reported an association between a variable measured before rtPA infusion and clinically important ICH (parenchymal ICH or ICH associated with clinical deterioration). We calculated associations between baseline variables and ICH with random-effect meta-analyses. RESULTS: We identified 55 studies that measured 43 baseline variables in 65 264 acute ischemic stroke patients. Post-rtPA ICH was associated with higher age (odds ratio, 1.03 per year; 95% confidence interval, 1.01-1.04), higher stroke severity (odds ratio, 1.08 per National Institutes of Health Stroke Scale point; 95% confidence interval, 1.06-1.11), and higher glucose (odds ratio, 1.10 per mmol/L; 95% confidence interval, 1.05-1.14). There was approximately a doubling of the odds of ICH with the presence of atrial fibrillation, congestive heart failure, renal impairment, previous antiplatelet agents, leukoaraiosis, and a visible acute cerebral ischemic lesion on pretreatment brain imaging. Little of the variation in the sizes of the associations among different studies was explained by the source of the cohort, definition of ICH, or degree of adjustment for confounding variables. CONCLUSIONS: Individual baseline variables were modestly associated with post-rtPA ICH. Prediction of post-rtPA ICH therefore is likely to be difficult if based on single clinical or imaging factors alone. These observational data do not provide a reliable method for the individualization of treatment according to predicted ICH risk.
BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rtPA) is an effective treatment for acute ischemic stroke but is associated with an increased risk of intracranial hemorrhage (ICH). We sought to identify the risk factors for ICH with a systematic review of the published literature. METHODS: We searched for studies of rtPA-treated strokepatients that reported an association between a variable measured before rtPA infusion and clinically important ICH (parenchymal ICH or ICH associated with clinical deterioration). We calculated associations between baseline variables and ICH with random-effect meta-analyses. RESULTS: We identified 55 studies that measured 43 baseline variables in 65 264 acute ischemic strokepatients. Post-rtPA ICH was associated with higher age (odds ratio, 1.03 per year; 95% confidence interval, 1.01-1.04), higher stroke severity (odds ratio, 1.08 per National Institutes of Health Stroke Scale point; 95% confidence interval, 1.06-1.11), and higher glucose (odds ratio, 1.10 per mmol/L; 95% confidence interval, 1.05-1.14). There was approximately a doubling of the odds of ICH with the presence of atrial fibrillation, congestive heart failure, renal impairment, previous antiplatelet agents, leukoaraiosis, and a visible acute cerebral ischemic lesion on pretreatment brain imaging. Little of the variation in the sizes of the associations among different studies was explained by the source of the cohort, definition of ICH, or degree of adjustment for confounding variables. CONCLUSIONS: Individual baseline variables were modestly associated with post-rtPA ICH. Prediction of post-rtPA ICH therefore is likely to be difficult if based on single clinical or imaging factors alone. These observational data do not provide a reliable method for the individualization of treatment according to predicted ICH risk.
Authors: James E Siegler; Steven R Messé; Heidi Sucharew; Scott E Kasner; Tapan Mehta; Niraj Arora; Amy K Starosciak; Felipe De Los Rios La Rosa; Natasha R Barnhill; Akshitkumar M Mistry; Kishan Patel; Salman Assad; Amjad Tarboosh; Katarina Dakay; Jeff Wagner; Alicia Bennett; Bharathi Jagadeesan; Christopher Streib; Stewart A Weber; Rohan Chitale; John J Volpi; Stephan A Mayer; Shadi Yaghi; Mahesh V Jayaraman; Pooja Khatri; Eva A Mistry Journal: J Neuroimaging Date: 2019-11-24 Impact factor: 2.486
Authors: Alexander D Horsch; Edwin Bennink; Tom van Seeters; L Jaap Kappelle; Yolanda van der Graaf; Willem P T M Mali; Hugo W A M de Jong; Birgitta K Velthuis; Jan Willem Dankbaar Journal: Cerebrovasc Dis Date: 2018-01-08 Impact factor: 2.762
Authors: Norbert Nighoghossian; Fatima Abbas; Tae-Hee Cho; Ana Filipa Geraldo; Vincent Cottaz; Elie Janecek; Laura Mechtouff; Magali Bischoff; Carlos El Khoury; Anne Marie Schott; Laurent Derex; Marc Hermier; Louis Guy Tisserand; Roxana Amelie; Leila Chamard; Yves Berthezene Journal: Neuroradiology Date: 2016-07-22 Impact factor: 2.804