Factors associated with intracerebral hemorrhage after thrombolytic therapy for ischemic stroke: pooled analysis of placebo data from the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II Trials.

Abstract

BACKGROUND AND PURPOSE:

A number of factors have been associated with postthrombolysis intracerebral hemorrhage, but these have varied across studies.

METHODS:

We examined patients with acute ischemic stroke treated with intravenous tissue plasminogen activator within 3 hours of symptom onset who were enrolled in the placebo arms of 2 trials (Stroke-Acute Ischemic NXY Treatment [SAINT] I and II Trials) of a putative neuroprotectant. Early CT changes were graded using the Alberta Stroke Program Early CT Score (ASPECTS). Post-tissue plasminogen activator symptomatic intracerebral hemorrhage was defined as a worsening in National Institutes of Health Stroke Scale of > or =4 points within 36 hours with evidence of hemorrhage on follow-up neuroimaging. Good clinical outcome was defined as a modified Rankin scale of 0 to 2 at 90 days.

RESULTS:

Symptomatic intracerebral hemorrhage occurred in 5.6% of 965 patients treated with tissue plasminogen activator. In multivariable analysis, symptomatic intracerebral hemorrhage was increased with baseline antiplatelet use (single antiplatelet: OR, 2.04, 95% CI, 1.07 to 3.87, P=0.03; double antiplatelet: OR, 9.29, 3.28 to 26.32, P<0.001), higher National Institutes of Health Stroke Scale score (OR, 1.09 per point, 1.03 to 1.15, P=0.002), and CT changes defined by ASPECTS (ASPECTS 8 to 9: OR, 2.26, 0.63 to 8.10, P=0.21; ASPECTS < or =7: OR, 5.63, 1.66 to 19.10, P=0.006). Higher National Institutes of Health Stroke Scale was associated with decreased odds of good clinical outcome (OR, 0.82 per point, 0.79 to 0.85, P<0.001). There was no relationship between baseline antiplatelet use or CT changes and clinical outcome.

CONCLUSIONS:

Along with higher National Institutes of Health Stroke Scale and extensive early CT changes, baseline antiplatelet use (particularly double antiplatelet therapy) was associated with an increased risk of post-tissue plasminogen activator symptomatic intracerebral hemorrhage. Of these factors, only National Institutes of Health Stroke Scale was associated with clinical outcome.

• Authors: Brett Cucchiara, Scott E Kasner, David Tanne, Steven R Levine, Andrew Demchuk, Steven R Messe, Lauren Sansing, Kennedy R Lees, Patrick Lyden, SAINT Investigators
• Journal: Stroke (Stroke) Vol. 40 Issue 9 Pg. 3067-72 (Sep 2009) ISSN: 1524-4628 [Electronic] United States
• PMID: 19608993 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (diagnosis, drug therapy)
• Cerebral Hemorrhage (chemically induced, diagnosis)
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Randomized Controlled Trials as Topic
• Risk Factors
• Stroke (diagnosis, drug therapy)
• Time Factors
• Tissue Plasminogen Activator (administration & dosage, adverse effects)
• Treatment Outcome