A multicenter retrospective study was performed in three comprehensive
stroke centers in China (West China Hospital, The First People's Hospital of Ziyang, and Mianyang Central Hospital) between January 1st 2012 and December 31th 2020. Participants were patients diagnosed with HT after intravenous thrombolytics on brain computed tomography (CT) within 36 h after
stroke onset. The treatment after thrombolysis related HT included aggressive
therapy (procoagulant, neurosurgical treatment) and
dehydration therapy (
mannitol or
glycerin and
fructose). The primary clinical outcome was 3-month death. The primary radiographic outcome was
hematoma expansion, defined as a 33% increase in the
hematoma volume using the (A × B × C)/2 method on follow-up imaging.
Results: Of 538 patients with
ischemic stroke receiving thrombolysis included during the study period, 94 patients (17.4%) were diagnosed with HT, 50% (47/94) of whom were symptomatic HT. The 3-month death was 31.5% (29/92), with two patients having been lost to follow up. A total of 68 patients (72.3%) had follow-up brain CT scans after HT detection for evaluating
hematoma expansion, of whom 14.7% (10/68) had
hematoma expansion. Among the 10 patients with
hematoma expansion, 7 patients were from symptomatic HT group, and 3 patients were from the asymptomatic
hematoma group. In regard to escalation in
therapy, six patients received neurosurgical treatment and three patients had a fresh frozen plasma infusion. In addition,
dehydration therapy was the most common management after HT diagnosis [87.2% (82 of 94)]. In the multivariable models, refusing any treatment after HT diagnosis was the sole factor associated with increased 3-month death (odds ratio, 13.6; 95% CI, 3.98-56.9) and
hematoma expansion risk (odds ratio, 8.54; 95% CI, 1.33-70.1). In regard to the effects of aggressive
therapy, a non-significant association of receiving
hemostatic/neurosurgery
therapy with a lower 3-month death and
hematoma expansion risk was observed (all P > 0.05).
Conclusion: Refusing any treatment after HT detection had a significant trend of increasing 3-month death and
hematoma expansion risk after HT. Our finding of
hematoma expansion among patients with asymptomatic HT in non-western populations suggests an opportunity for intervention. Very few patients after thrombolysis related HT diagnosis received procoagulant or neurosurgical
therapies. Large multicenter studies enrolling diverse populations are needed to examine the efficacy of these
therapies on different HT subtypes.