Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis?

Sang Hwa Lee, Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Jun Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik Hong, Jay Chol ChoiJoon Tae Kim, Kangho Choi, Dong Eog Kim, Wi Sun Ryu, Wook Joo Kim, Dong Ick Shin, Minju Yeo, Juneyoung Lee, Ji Sung Lee, Philip B. Gorelick, Hee Joon Bae

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Current guidelines have contraindicated history of intracerebral hemorrhage for intravenous recombinant tissue plasminogen activator. Aim: This study aimed to investigate the safety and effectiveness of intravenous recombinant tissue plasminogen activator for patients who had previous intracerebral hemorrhage on history or initial brain magnetic resonance imaging. Methods: Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 4.5 h of onset. Previous intracerebral hemorrhage was defined as having a clinical history or evidence of old intracerebral hemorrhage on initial brain magnetic resonance imaging. Associations of previous intracerebral hemorrhage with symptomatic hemorrhagic transformation during hospitalization and functional outcome and mortality at discharge and three months were analyzed. Results: Among 1495 patients who were treated with intravenous recombinant tissue plasminogen activator, 73 (4.9%) had previous intracerebral hemorrhage; 9 on history only, 61 on magnetic resonance imaging only and 3 on both. Of those 1495 patients, 71 (4.7%) experienced symptomatic hemorrhagic transformation; 6.8% in patients with previous intracerebral hemorrhage and 4.6% in those without previous intracerebral hemorrhage. Multivariable logistic regression analysis showed that previous intracerebral hemorrhage did not significantly increase the risk of symptomatic hemorrhagic transformation (odds ratio 1.08, 95% confidence interval 0.39–2.96) mortality, and most of functional outcome measures Conclusions: Previous intracerebral hemorrhage may neither increase the risk of symptomatic hemorrhagic transformation nor alter major clinical outcomes in acute ischemic stroke patients receiving intravenous recombinant tissue plasminogen activator. This study suggests reconsideration of prior history of intracerebral hemorrhage as an exclusion criterion for intravenous recombinant tissue plasminogen activator administration in acute ischemic stroke.

Original languageEnglish
Pages (from-to)783-790
Number of pages8
JournalInternational Journal of Stroke
Volume11
Issue number7
DOIs
Publication statusPublished - 2016 Oct 1

Keywords

  • Acute ischemic stroke
  • brain macrobleed
  • history of intracerebral hemorrhage
  • intravenous thrombolysis
  • mortality
  • symptomatic hemorrhagic transformation

ASJC Scopus subject areas

  • Neurology

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    Lee, S. H., Kim, B. J., Han, M. K., Park, T. H., Lee, K. B., Lee, B. C., Yu, K. H., Oh, M. S., Cha, J. K., Kim, D. H., Nah, H. W., Lee, J., Lee, S. J., Ko, Y., Kim, J. G., Park, J. M., Kang, K., Cho, Y. J., Hong, K. S., ... Bae, H. J. (2016). Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis? International Journal of Stroke, 11(7), 783-790. https://doi.org/10.1177/1747493016654289