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Safety of Intravenous Thrombolysis in Chronic Intracranial Hemorrhage: A Five-Year Multicenter Study
R. Zand, G. Tsivgoulis, A. Sadighi, M. Singh, M. McCormack, S. Shahjouei, N. Goyal, N. Noorbakhsh-Sabet, AW. Alexandrov, AV. Alexandrov,
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie
- MeSH
- bezpečnost pacientů MeSH
- časové faktory MeSH
- centra terciární péče MeSH
- cévní mozková příhoda komplikace diagnostické zobrazování farmakoterapie mortalita MeSH
- chronická nemoc MeSH
- fibrinolytika aplikace a dávkování škodlivé účinky MeSH
- hodnocení rizik MeSH
- intrakraniální krvácení komplikace diagnostické zobrazování mortalita MeSH
- intravenózní infuze MeSH
- ischemie mozku komplikace diagnostické zobrazování farmakoterapie mortalita MeSH
- klinické rozhodování MeSH
- léková kontraindikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mortalita v nemocnicích MeSH
- posuzování pracovní neschopnosti MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombolytická terapie škodlivé účinky mortalita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Řecko MeSH
- Spojené státy americké MeSH
INTRODUCTION: Although the recently updated U.S. alteplase label removed "history of intracranial hemorrhage (ICH)" as a contraindication, there are very limited data on the safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with chronic ICH. We sought to evaluate IVT safety in AIS patients with a history of ICH. METHODS: We analyzed consecutive AIS patients treated with IVT at 3 tertiary stroke centers during a 5-year period. We identified AIS treated with IVT with clinical history and neuroimaging confirmation of prior ICH. The safety measure was symptomatic ICH (sICH) defined according to European Cooperative Acute Stroke Study-III criteria combined with the clinical deterioration of 4 points or higher in the National Institutes of Health Stroke Scale (NIHSS) or death. RESULTS: Of the 1212 AIS patients treated with IVT, 7 (.6%) (mean age 72 ± 11 years, 57% men, median NIHSS: 5 points, interquartile range: 2-8) had a history of ICH (hematoma volume: 1-21 cm3, elapsed time between previous ICH and AIS: 1.5-12 years, 5 located in basal ganglia and 2 in periventricular white matter). Patients with previous ICH did not differ in terms of demographics and admission stroke severity in comparison with the rest. The 2 groups had similar rates of sICH (0% [0/7] versus 3.6%, P = .61) and in-hospital mortality (0% [0/7] versus 6.0%, P = .50). CONCLUSION: Our study indicates that IVT might be safe among AIS patients with a history of chronic ICH. Further research with a larger sample size is required to confirm our finding and define the shortest time interval between the hemorrhagic and ischemic events that can be associated with the safe administration of IVT.
Department of Neurology Geisinger Health System Danville Pennsylvania
Department of Neurology University of Tennessee Health Science Center Memphis Tennessee
International Clinical Research Center St Anne's Hospital Brno Czech Republic
Citace poskytuje Crossref.org
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- $a Zand, Ramin $u Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Neurology, Geisinger Health System, Danville, Pennsylvania. Electronic address: ramin.zand@gmail.com.
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- $a INTRODUCTION: Although the recently updated U.S. alteplase label removed "history of intracranial hemorrhage (ICH)" as a contraindication, there are very limited data on the safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with chronic ICH. We sought to evaluate IVT safety in AIS patients with a history of ICH. METHODS: We analyzed consecutive AIS patients treated with IVT at 3 tertiary stroke centers during a 5-year period. We identified AIS treated with IVT with clinical history and neuroimaging confirmation of prior ICH. The safety measure was symptomatic ICH (sICH) defined according to European Cooperative Acute Stroke Study-III criteria combined with the clinical deterioration of 4 points or higher in the National Institutes of Health Stroke Scale (NIHSS) or death. RESULTS: Of the 1212 AIS patients treated with IVT, 7 (.6%) (mean age 72 ± 11 years, 57% men, median NIHSS: 5 points, interquartile range: 2-8) had a history of ICH (hematoma volume: 1-21 cm3, elapsed time between previous ICH and AIS: 1.5-12 years, 5 located in basal ganglia and 2 in periventricular white matter). Patients with previous ICH did not differ in terms of demographics and admission stroke severity in comparison with the rest. The 2 groups had similar rates of sICH (0% [0/7] versus 3.6%, P = .61) and in-hospital mortality (0% [0/7] versus 6.0%, P = .50). CONCLUSION: Our study indicates that IVT might be safe among AIS patients with a history of chronic ICH. Further research with a larger sample size is required to confirm our finding and define the shortest time interval between the hemorrhagic and ischemic events that can be associated with the safe administration of IVT.
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