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Prevalence, risk factors, and clinical outcomes of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis

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Abstract

Background

Hemorrhagic transformation (HT) is a common complication of alteplase treatment. However, the prevalence rate, risk factors, and clinical outcomes of remote intracerebral hemorrhage (rICH) after intravenous thrombolysis in acute ischemic stroke are not well understood.

Methods

Following a previously registered protocol, the PubMed, Web of Science, and Embase databases were systematically searched to identify relevant literature up to June 2022. Cohort studies reporting thrombolysis-related rICH in patients with acute ischemic stroke were included. Random effects models were used to calculate pooled prevalence rate, mean difference (MD) or odds ratio (OR) with corresponding 95% confidence interval (CI).

Results

Fourteen studies with 52,610 patients were included in this meta-analysis. The pooled rICH prevalence was 3.2% (95% CI 3.1–3.4%). Compared to patients without intracerebral hemorrhage (ICH), those with rICH were older, more likely to be female, and had a higher proportion of prior stroke, chronic heart failure and cardioembolism, and higher diastolic blood pressure. Small vessel disease markers (e.g., white matter hyperintensities and cerebral microbleeds) were strongly associated with rICH. The presence of rICH decreased the likelihood of favorable outcomes (OR 0.36, 95% CI 0.31–0.41) and increased the risk of mortality (OR 4.37, 95% CI 2.86–6.67).

Conclusions

Although rICH is uncommon after intravenous thrombolysis, its presence can lead to worse functional outcomes and higher mortality in acute ischemic stroke. Patients at high risk of rICH must be identified based on potential risk factors.

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Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors wish to acknowledge Dr. Zhao Han, Professor of neurology, Wenzhou Medical University, for his help in interpreting the significance of the results of this study

Funding

This work was supported by the Medical Science and Technology Project of Zhejiang Province of China (No.2021KY797).

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Authors and Affiliations

  1. Department of Neurology, Taizhou Municipal Hospital, Taizhou, China

    Lingling Qiu & Jinfeng He

  2. Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Fangwang Fu & Zhenxiang Zhan

  3. Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China

    Wenyuan Zhang

  4. Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China

    Zicheng Cheng

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  1. Lingling Qiu
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  3. Wenyuan Zhang
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  4. Jinfeng He
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  5. Zhenxiang Zhan
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Contributions

ZC conceived and designed the study. LQ, FF and WZ performed the literature search and data extraction. JH, ZZ and ZC assisted in data analysis. LQ wrote the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Zicheng Cheng.

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Ethical approval was not needed, as no individual-level data were utilized.

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Qiu, L., Fu, F., Zhang, W. et al. Prevalence, risk factors, and clinical outcomes of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis. J Neurol 270, 651–661 (2023). https://doi.org/10.1007/s00415-022-11414-2

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  • DOI: https://doi.org/10.1007/s00415-022-11414-2

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