Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation

Ju Hun Lee, Kwang Yeol Park, Joon Hyun Shin, Jae Kwan Cha, Hahn Young Kim, Jee Hyun Kwon, Hyung Geun Oh, Kyung Bok Lee, Dong Eog Kim, Sang Won Ha, Kyung-Hee Cho, Sung Il Sohn, Mi Sun Oh, Kyung Ho Yu, Byung Chul Lee, Sun U. Kwon

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 104 increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.

Original languageEnglish
Pages (from-to)193-200
Number of pages8
JournalEuropean Neurology
Volume64
Issue number4
DOIs
Publication statusPublished - 2010 Oct 1
Externally publishedYes

Fingerprint

Atrial Fibrillation
Stroke
Platelet Count
Thrombolytic Therapy
Cerebral Hemorrhage
Middle Cerebral Artery
Korea
Safety

Keywords

  • Acute ischemic stroke
  • Anticoagulation
  • Atrial fibrillation
  • Hemorrhagic transformation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Lee, J. H., Park, K. Y., Shin, J. H., Cha, J. K., Kim, H. Y., Kwon, J. H., ... Kwon, S. U. (2010). Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation. European Neurology, 64(4), 193-200. https://doi.org/10.1159/000319048

Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation. / Lee, Ju Hun; Park, Kwang Yeol; Shin, Joon Hyun; Cha, Jae Kwan; Kim, Hahn Young; Kwon, Jee Hyun; Oh, Hyung Geun; Lee, Kyung Bok; Kim, Dong Eog; Ha, Sang Won; Cho, Kyung-Hee; Sohn, Sung Il; Oh, Mi Sun; Yu, Kyung Ho; Lee, Byung Chul; Kwon, Sun U.

In: European Neurology, Vol. 64, No. 4, 01.10.2010, p. 193-200.

Research output: Contribution to journalArticle

Lee, JH, Park, KY, Shin, JH, Cha, JK, Kim, HY, Kwon, JH, Oh, HG, Lee, KB, Kim, DE, Ha, SW, Cho, K-H, Sohn, SI, Oh, MS, Yu, KH, Lee, BC & Kwon, SU 2010, 'Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation', European Neurology, vol. 64, no. 4, pp. 193-200. https://doi.org/10.1159/000319048
Lee, Ju Hun ; Park, Kwang Yeol ; Shin, Joon Hyun ; Cha, Jae Kwan ; Kim, Hahn Young ; Kwon, Jee Hyun ; Oh, Hyung Geun ; Lee, Kyung Bok ; Kim, Dong Eog ; Ha, Sang Won ; Cho, Kyung-Hee ; Sohn, Sung Il ; Oh, Mi Sun ; Yu, Kyung Ho ; Lee, Byung Chul ; Kwon, Sun U. / Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation. In: European Neurology. 2010 ; Vol. 64, No. 4. pp. 193-200.
@article{bae2a72466ad42109f248c62028d8b6c,
title = "Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation",
abstract = "Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50{\%} or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67{\%}) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6{\%}. Large infarct (OR 6.38, 95{\%} CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 104 increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.",
keywords = "Acute ischemic stroke, Anticoagulation, Atrial fibrillation, Hemorrhagic transformation",
author = "Lee, {Ju Hun} and Park, {Kwang Yeol} and Shin, {Joon Hyun} and Cha, {Jae Kwan} and Kim, {Hahn Young} and Kwon, {Jee Hyun} and Oh, {Hyung Geun} and Lee, {Kyung Bok} and Kim, {Dong Eog} and Ha, {Sang Won} and Kyung-Hee Cho and Sohn, {Sung Il} and Oh, {Mi Sun} and Yu, {Kyung Ho} and Lee, {Byung Chul} and Kwon, {Sun U.}",
year = "2010",
month = "10",
day = "1",
doi = "10.1159/000319048",
language = "English",
volume = "64",
pages = "193--200",
journal = "European Neurology",
issn = "0014-3022",
publisher = "S. Karger AG",
number = "4",

}

TY - JOUR

T1 - Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation

AU - Lee, Ju Hun

AU - Park, Kwang Yeol

AU - Shin, Joon Hyun

AU - Cha, Jae Kwan

AU - Kim, Hahn Young

AU - Kwon, Jee Hyun

AU - Oh, Hyung Geun

AU - Lee, Kyung Bok

AU - Kim, Dong Eog

AU - Ha, Sang Won

AU - Cho, Kyung-Hee

AU - Sohn, Sung Il

AU - Oh, Mi Sun

AU - Yu, Kyung Ho

AU - Lee, Byung Chul

AU - Kwon, Sun U.

PY - 2010/10/1

Y1 - 2010/10/1

N2 - Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 104 increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.

AB - Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 104 increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.

KW - Acute ischemic stroke

KW - Anticoagulation

KW - Atrial fibrillation

KW - Hemorrhagic transformation

UR - http://www.scopus.com/inward/record.url?scp=77955547355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955547355&partnerID=8YFLogxK

U2 - 10.1159/000319048

DO - 10.1159/000319048

M3 - Article

C2 - 20714158

AN - SCOPUS:77955547355

VL - 64

SP - 193

EP - 200

JO - European Neurology

JF - European Neurology

SN - 0014-3022

IS - 4

ER -