Abstract
Intracranial bleeding is the principal safety concern and use-limiting factor related to the application of thrombolytic agents in acute stroke. Several recent studies, using intravenously administered recombinant tissue plasminogen activator (rt-PA) for carotid and vertebrobasilar territory stroke, have documented intracranial bleeding in the form of hemorrhagic infarction (HI) and parenchymatous hematoma (PH) [2, 4, 11, 16, 19]. That intracranial bleeding is not limited to the use of thrombolytic agents in stroke patients has been amply documented in studies of patients with acute myocardial infarction treated with these agents where a small but consistent incidence has been noted in the range of approximately 0.5% (Table 1) [6, 7, 9, 10, 14, 15, 18]. The purpose of this discussion is to examine several factors presumed to be associated with intracranial bleeding in stroke patients treated with thrombolytic agents using data from the rt-PA Acute Stroke Study Group trial [4] and other recent trials [2, 8, 11, 16, 19]. A preview of this analysis suggests that many of the long and firmly held views regarding influences and effects of hemorrhagic transformation (HT) are not supported by recent information.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Bozzao L, Angeloni U, Bastianello S, Fantozzi LM, Pierallini A, Fieschi C (1991) Early angiographic and CT findings in patients with hemorrhagic infarction in the distribution of the middle cerebral artery. AJNR 12:1115–1121
Brott TG, Haley EC, Levy DE, et al (1992) Urgent therapy for stroke. Part I. Pilot study of tissue plaminogen activator administered within 90 minutes. Stroke 23:632–640
Cerebral Embolism Study Group (1984) Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options. Stroke 15:779–789
del Zoppo GJ, Poeck K, Pessin MS, and 16 coauthors of the rt-PA Acute Stroke Study Group (1992) Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 32:78–86
Fisher CM, Adams RD (1951) Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction. J Neuropathol Exp Neurol 10:92–94
Gore JM, Sloan M, Price TR, et al (1991) Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the thrombolysis in myocardial infarction study. Thrombolysis in myocardial infarction, Phase II, pilot and clinical trial. Circulation 83:448–459
Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (1990) GISSI-2: A factorial randomised trial of alteplace versus streptokinase and heparin versus no heparin among 12, 490 patients with acute myocardial infarction. Lancet 336:65–71
Haley EC, Levy DE, Brott TG, et al (1992) Urgent therapy for stroke. Part II. Pilot study of tissue plasminogen activator administered 91–180 minutes from onset. Stroke 23:641–645
International Study Group (1992) In-hospital mortality and clinical course of 20, 891 patients with suspected acute myocardial infarction randomized between alteplase and streptokinase with or without heparin. Lancet 536:71–75
Kase CS, Pessin MS, Zivin JA, et al (1992) Intracranial hemorrhage following coronary thrombolysis with tissue plasminogen activator. Am J Med 92:384–390
Mori E, Yoneda Y, Tabuchi M, et al (1992) Intravenous recombinant tissue plasminogen activator in acute carotid artery territory stroke. Neurology 42:976–982
Ogata J, Yutani C, Imakita M, et al (1989) Hemorrhagic infarct of the brain without a reopening of the occluded arteries in cardioembolic stroke. Stroke 20:876–883
Okada Y, Yamaguchi T, Minematsu K, et al (1989) Hemorrhagic transformation in cerebral embolism. Stroke 20:598–603
Sloan MA, Price TR (1991) Intracranial hemorrhage following thrombolytic therapy for acute myocardial infarction. Semin Neurol 11:385–399
Uglietta JP, O’Connor CM, Boyko OB, Aldrich H, Massey EW, Heinz ER (1991) CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction. Radiology 181:555–559
von Kummer R, Hacke W (1992) Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery. Stroke 23:646–652
Warach S, Chien D, Li W, Ronthal M, Edelman RR (1992) Fast magnetic resonance diffusion-weighted imaging of acute human stroke. Neurology 42:1717–1723
Wilcox RG, Olsson CG, Skene AM, et al (1988) Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 2:525–530
Yamaguchi T, Hayakawa T, Kikuchi H, Abe T (1991) Thrombolytic therapy in embolic and thrombotic cerebral infarction: A cooperative study. In: Hacke W, del Zoppo GJ, Hirschberg M (eds) Thrombolytic therapy in acute stroke. Springer-Verlag, Berlin Heidelberg New York, p 168
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Pessin, M.S., Wolpert, S.M. (1993). The Significance of Various Factors Associated with Hemorrhagic Transformation in Patients Treated with Recombinant Tissue Plasminogen Activator for Acute Stroke. In: del Zoppo, G.J., Mori, E., Hacke, W. (eds) Thrombolytic Therapy in Acute Ischemic Stroke II. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78061-5_21
Download citation
DOI: https://doi.org/10.1007/978-3-642-78061-5_21
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-56442-3
Online ISBN: 978-3-642-78061-5
eBook Packages: Springer Book Archive