Predictors of Symptomatic Intracerebral Haemorrhage after Systemic Thrombolysis for Cerebral Infarction
Abstract
Background: Symptomatic intracerebral hemorrhage (SICH ) following thrombolytic therapy for stroke is associated with a high rate of morbidity and mortality. The aim of our study was to demonstrate predictive value of SICH for good clinical outcome measured by modified Rankin scale (mRS ) and to identify predictors of SICH in patients after systemic thrombolysis in the Czech Republic.
Methods: Data collected from the SITS registry (Safe Implementation of Treatments in Stroke) of Czech patients treated with intravenous thrombolysis between February 2003 and February 2010 were analyzed with uni- and multivariate regression analysis. The outcome variable was SICH , defined as deterioration in NIHSS GREATER-THAN OR EQUAL TO 4 points and intracerebral hemorrhage type 2 within 22-36 hours from the start of thrombolysis.
Results: A total of 2821 patients with ischemic stroke were treated with intravenous thrombolysis. SICH were observed in 60 (2.1%) patients.
Patients with SICH were by 87% less likely to reach mRS 0-1 three months after thee stroke (OR = 0.13; 95% CI 0.04-0.44). The following independent predictors of SICH were identified: baseline NIHSS >12 (OR 0.4; 95% CI 0.25-0.79), glucose (OR 1.1, 95% CI 1.03-1.18), congestive heart failure (OR 2.1; 95% CI 1.1-4.02), hypertension (OR 2.4; 95% CI 1.03-5.81).
Conclusions: In the Czech Republic, the frequency of symptomatic bleeding after thrombolysis was similar to other countries. SICH significantly worsened prognosis of patients after thrombolysis.
Patients with hypertension, higher glucose level, more severe stroke and presence of congestive heart failure were at higher risk of SICH. Our data are useful when stratifying the risk after intravenous thrombolysis.