Thanin Lokeskrawee1, Sombat Muengtaweepongsa2, Jayanton Patumanond3, Somsak Tiamkao4, Thanoot Thamangraksat5, Phanyarat Phankhian6, Polchai Pleumpanupat7, Paworamon Sribussara7, Teeraparp Kitjavijit7, Anake Supap8, Weerawan Rattanaphibool8, Jariya Prisiri9. 1. Department of Emergency Medicine, Lampang Hospital, Lampang, Thailand. 2. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. Electronic address: sombatm@hotmail.com. 3. Division of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. 4. Division of Neurology, Department of Internal Medicine, North Eastern Research Group, Khon Kaen University, Khon Kaen, Thailand. 5. Division of Neurology, Department of Internal Medicine, Chiangrai Hospital, Chiangrai, Thailand. 6. Division of Neurology, Department of Internal Medicine, Uttaradit Hospital, Uttaradit, Thailand. 7. Division of Neurology, Department of Internal Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand. 8. Department of Emergency Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand. 9. Department of Internal Medicine, Nan Hospital, Nan, Thailand.
Abstract
BACKGROUND: Symptomatic intracranial hemorrhage (sICH) is common after intravenous thrombolysis in acute ischemic strokes (AISs). Available predictive scoring systems were derived mostly in the Western countries. METHODS: Retrospective data in 1 provincial and 4 regional hospitals in the northern part of Thailand were reviewed. Patients with AIS, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed, were classified into 3 groups: no intracranial hemorrhage (no ICH), asymptomatic intracranial hemorrhage (asICH) and sICH. Coefficients under the multilevel ordinal logistic model were transformed into item scores and sum scores. Measures of discrimination, calibration, and internal validation were analyzed. RESULTS: Among 1172 patients, there were 78.8% with no ICH (n = 923), 13.1% with asICH (n = 154), and 8.1% with sICH (n = 95). The final model was named "SICH score" and included 6 variables: valvular heart diseases, use of aspirin, systolic blood pressure prior to thrombolysis that is 140 mmHg or higher, National Institutes of Health Stroke Scale scores higher than 10 and 20, a platelet count lower than 250,000 cell/mm3, and use of intravenous antihypertensive drugs during thrombolysis, with an Area under Receiver Operating Characteristic of .75 (95% confidence interval, .71-.80). CONCLUSION: The SICH score could be an assisting tool to predict an individual risk of sICH after intravenous thrombolysis for AIS in Thai patients.
BACKGROUND: Symptomatic intracranial hemorrhage (sICH) is common after intravenous thrombolysis in acute ischemic strokes (AISs). Available predictive scoring systems were derived mostly in the Western countries. METHODS: Retrospective data in 1 provincial and 4 regional hospitals in the northern part of Thailand were reviewed. Patients with AIS, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed, were classified into 3 groups: no intracranial hemorrhage (no ICH), asymptomatic intracranial hemorrhage (asICH) and sICH. Coefficients under the multilevel ordinal logistic model were transformed into item scores and sum scores. Measures of discrimination, calibration, and internal validation were analyzed. RESULTS: Among 1172 patients, there were 78.8% with no ICH (n = 923), 13.1% with asICH (n = 154), and 8.1% with sICH (n = 95). The final model was named "SICH score" and included 6 variables: valvular heart diseases, use of aspirin, systolic blood pressure prior to thrombolysis that is 140 mmHg or higher, National Institutes of Health Stroke Scale scores higher than 10 and 20, a platelet count lower than 250,000 cell/mm3, and use of intravenous antihypertensive drugs during thrombolysis, with an Area under Receiver Operating Characteristic of .75 (95% confidence interval, .71-.80). CONCLUSION: The SICH score could be an assisting tool to predict an individual risk of sICH after intravenous thrombolysis for AIS in Thai patients.
Authors: Na Xu; Zhouqing Chen; Chongshun Zhao; Tao Xue; Xin Wu; Xiaoou Sun; Zhong Wang Journal: Drug Des Devel Ther Date: 2018-07-06 Impact factor: 4.162