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Early computed tomography signs as early predictors of hemorrhagic transformation under heparinization in patients with cardiogenic embolism
Author(s) -
Terao Takeshi,
Mishina Masahiro,
Takumi Ichiro,
Komaba Yuichi,
Mizunari Takayuki,
Kobayashi Shiro,
Yoshida Daizo,
Teramoto Akira
Publication year - 2012
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/j.1447-0594.2011.00782.x
Subject(s) - medicine , thrombolysis , cardiology , hematoma , hyperlipidemia , stroke (engine) , logistic regression , diabetes mellitus , radiology , myocardial infarction , mechanical engineering , engineering , endocrinology
Aim: Early computed tomography (CT) signs are crucial to predict the onset of hemorrhagic transformation (HT) and are preventive to avoid a fatal hematoma after thrombolysis. In the present study, we retrospectively reviewed the clinical records of patients receiving heparinization to investigate the correlation between early CT signs and the frequency of HT. Methods: We reviewed 96 patients with cardiogenic cerebral embolism. These patients were admitted within 24 h of the onset and were subsequently given 5000–15 000 units of heparin per day for 3 days. Owing to CT on admission, early CT changes were evaluated. Patient characteristics were also estimated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease and history of smoking. The probability of hemorrhagic transformation, or good outcome and independence was assessed by backward stepwise logistic regression analysis based on the maximum likelihood ratio. Results: Higher baseline National Institutes of Health Stroke Scale (NIHSS) score, early CT signs and absence of hyperlipidemia diversely correlated with the occurrence of HT. Also, the presence or absence of early CT signs was significantly related to HT classification (χ 2 ‐test; P < 0.05). It was statistically significant that a higher baseline NIHSS score (OR 8.51; 95% CI 3.11–27.75) affected the outcome without showing a significant relationship to early CT signs. Conclusions: Presence of early CT signs correlated more strongly with HT than with the interval from symptom onset to hospital arrival. We might extend the therapeutic time for thrombolytic therapy, only if the early CT sign does not appear. Geriatr Gerontol Int 2012; 12: 418–424.