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Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis

Neurocritical Care volume 23, pages 394–400 (2015)Cite this article

Abstract

Introduction

Symptomatic intracranial hemorrhage (sICH) is a serious complication of IV rt-PA therapy after acute ischemic stroke. Independent sICH predictors have been previously derived using case–control studies. Here we utilized a novel cohort-based comparison to identify additional independent predictors of sICH.

Methods

We included 210 patients receiving IV rt-PA therapy from January 2009 through December 2013 at the Yale-New Haven Stroke Center. Clinical parameters were compared using Mann–Whitney tests, two-sample tests of proportions and two-sample t tests. Logistic regression was performed using sICH as the dependent variable. Predictive ability was assessed using areas under the receiver operating characteristic (ROC) curve.

Results

sICH rates were lowest from 2010 to 2012 and comprised the low sICH cohort (2.0 % sICH), compared to the high sICH cohort from 2009 to 2013 (9.2 % sICH, P = 0.025). Patients in the low sICH cohort had significantly more visual field deficits (38.6 vs. 24.8 %, P = 0.03) and decreased levels of consciousness (62.4 vs. 39.4 %, P < 0.001), but fewer hyperdense MCA signs (5 vs. 13.8 %, P = 0.03) and early CT hypodensities (14.9 vs. 29.4 %, P = 0.01). These four parameters together predicted sICH modestly (area under ROC curve 0.66, odds ratio 2.72, P = 0.03)

Conclusions

Using a novel cohort-based approach, we identified two new independent predictors of sICH after IV rt-PA therapy: the presence of the hyperdense MCA sign and early CT hypodensities. Novel methods are needed to reduce the risk of sICH for patients receiving antithrombolytic therapy for ischemic stroke.

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Acknowledgments

No authors have financial relationships relevant to this manuscript.

Disclosure

Dr. Asuzu , Ms. Nystrom, Dr. Amin, Dr. Schindler, Dr. Wira, Dr. Greer, Dr. Chi, Ms. Halliday, Dr. Sheth they have no disclosures.

Author information

Affiliations

  1. Department of Neurology, Yale School of Medicine, 15 York Street, LCI 10, New Haven, CT, 06510, USA

    David Asuzu, Joseph Schindler, Charles Wira, David Greer & Kevin N. Sheth

  2. Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Emergency Medicine, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA

    Karin Nyström, Hardik Amin, Joseph Schindler, Charles Wira, David Greer, Janet Halliday & Kevin N. Sheth

  3. Department of Neurology, Taipei Medical University Hospital and Shuang Ho Hospital, Taipei, Taiwan

    Nai Fang Chi

Authors
  1. David Asuzu
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  2. Karin Nyström
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  3. Hardik Amin
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  7. Nai Fang Chi
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  8. Janet Halliday
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  9. Kevin N. Sheth
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Correspondence to Kevin N. Sheth.

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Asuzu, D., Nyström, K., Amin, H. et al. Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocrit Care 23, 394–400 (2015). https://doi.org/10.1007/s12028-015-0121-1

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Keywords

  • IV Thrombolysis
  • Intracerebral hemorrhage
  • Neurocritical care