Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke - PubMed (original) (raw)

Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke

Patrick M Chen et al. Neurol Clin Pract. 2019 Aug.

Abstract

Background: We investigated patterns in the time from recombinant tissue-type plasminogen activator (rt-PA) treatment to symptomatic intracranial hemorrhage (sICH) onset in acute ischemic stroke.

Methods: We retrospectively reviewed all admitted "stroke code" patients from 2003 to 2017 at the University of California San Diego Medical Center from a prospective stroke registry. We selected patients that received IV rt-PA within 4.5 hours after onset/last known well and had sICH prehospital discharge. sICH diagnosis was made by prospective review. Endovascular-treated patients were excluded, given the variability of practice. sICH was prospectively defined as any new radiographic (CT/MRI) hemorrhage after rt-PA treatment and any worsened neurologic examination. Time to sICH was the time from rt-PA administration start to documented STAT head CT order time with the first evidence of new hemorrhage. Charts were reviewed for examination time metrics, demographics, clinical history, and neuroimaging.

Results: sICH was identified in 28 rt-PA-only treated patients. The mean time to sICH was 18.28 hours (range 2.4-34 hours). Median time to sICH was 18.25 hours. sICH was correlated with increased age (p = 0.02) and increased NIH Stroke Scale (p = 0.01).

Conclusions: Our findings suggest that rt-PA patients have the highest risk of post rt-PA sICH within the first 24 hours after treatment. This supports monitoring of rt-PA-treated patients in specialized settings such as neuro-intensive care units or stroke units. Our findings suggest that the probability of sICH is low 36 hours post rt-PA. Future larger studies are warranted to identify the patterns of bleeding after rt-PA administration.

© 2019 American Academy of Neurology.

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Figures

Figure

Figure. Timing of symptomatic intracranial hemorrhage (sICH) after recombinant tissue-type plasminogen activator (rt-PA)

References

    1. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587. -PubMed
    1. Yaghi S, Willey JZ, Cucchiara B, et al. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: a scientific statement for healthcare professionals from the American Heart association/American stroke association. Stroke 2017;48:e343–e361. -PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart association/American stroke association. Stroke 2018;49:e46–e110. -PubMed
    1. Faigle R, Sharrief A, Marsh EB, Llinas RH, Urrutia VC. Predictors of critical care needs after IV thrombolysis for acute ischemic stroke. PLoS One 2014;9:e88652. -PMC -PubMed
    1. George AJ, Boehme AK, Dunn CR, et al. Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients. Int J Stroke 2015;10:37–41. -PMC -PubMed

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