Open AccessHemorrhagic transformation after thrombolysis in acute ischemic stroke: a single-center crosssectional study
Author(s) -
Rônney Pinto Lopes,
Matheus Gonçalves Maia,
Lohana Santana Almeida da Silva,
Luiza Ramos de Freitas,
Natália Trombini Mendes,
Paulo Henrique Maia de Freitas,
Tamara Melissa Zavadzki Albuquerque,
Vivian Dias Baptista Gagliardi,
Rubens José Gagliardi
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.658
Subject(s) - medicine , thrombolysis , diabetes mellitus , stroke (engine) , complication , cryoprecipitate , mortality rate , medical record , retrospective cohort study , atrial fibrillation , surgery , myocardial infarction , fibrinogen , endocrinology , mechanical engineering , engineering
Background: Intravenous thrombolysis is the standard medical treatment for acute ischemic stroke (AIS) within 4.5 hours of symptom onset, and symptomatic hemorrhagic transformation (sHT) is the most feared complication of this treatment. Objective: To describe the prevalence, risk factors, treatment and outcome of sHT. Design and setting: This is a retrospective cross-sectional study in a quaternary care hospital in Sao Paulo, Brazil. Methods: We reviewed 90 records of patients with AIS submitted to thrombolysis from March 2018 to February 2020. Evaluation of brain imaging after thrombolysis and the treatment initiated after detection of hemorrhage were made. Results: The overall prevalence of HT was 18.9% (n = 17, mean age 69.4±14.6 years, 58.8% males) and 8.9% (n = 8) of sHT. The most prevalent comorbidities were renal impairment (82%), hypertension (76.4%), diabetes mellitus (35.2%), atrial fibrillation (35.2%) and smoking (35.2%). The median baseline NIHSS score was 17. The most prevalent radiological classification of post-thrombolysis HT was class 2 (41.1%) from the Heidelberg Bleeding Classification. Cryoprecipitate and tranexamic acid were administered in 11.8% (n = 2). The mortality rate for HT was 35.3% (n = 6). Antiplatelet or anticoagulant therapy was initiated after a mean of 24.6 days from HT diagnosis and there was no stroke recurrence at 90 days. Conclusion: We showed a prevalence of sHT and related risk factors aligned with other studies, but with high mortality rates, despite being a stroke service. The late initiation of antiplatelets or anticoagulants did not lead to stroke recurrence at 90 days.