University of São Paulo, Ribeirão Preto School of Medicine, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto/SP, Brazil.
Clinics (Sao Paulo). 2012 Jul;67(7):739-43. doi: 10.6061/clinics/2012(07)06.
Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil.
We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation.
In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p = 0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage.
In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis.
南美的急性脑卒中静脉溶栓后症状性颅内出血的相关数据十分有限。我们旨在探讨巴西一家三级急救单位卒中溶栓后症状性颅内出血的发生率和临床预测因子。
我们回顾了 2001 年 5 月至 2010 年 4 月在我院接受静脉溶栓治疗的 117 例连续急性缺血性脑卒中患者的临床和影像学资料。我们将我们的结果与 Safe Implementation of Thrombolysis in Stroke 登记处的结果进行了比较。进行了单变量和多变量回归分析，以确定与症状性颅内转化相关的因素。
总共分析了初始样本中的 113 例。美国国立卫生研究院卒中量表（NIHSS）评分中位数为 16 分（四分位距：10-20）。发病至治疗时间中位数为 188 分钟（四分位距：155-227）。共有 7 例症状性颅内出血（6.2%；Safe Implementation of Thrombolysis in Stroke 登记处：4.9%；p=0.505）。在单变量分析中，当前他汀类药物治疗和 NIHSS 评分升高与症状性颅内出血有关。在多变量分析后，当前他汀类药物治疗是唯一与症状性颅内出血独立相关的因素。
在这项巴西系列研究中，严重脑卒中患者在大学附属医院的较晚治疗窗口接受静脉溶栓治疗，我们没有发现症状性颅内出血的发生率增加。需要进一步的研究来阐明他汀类药物与卒中溶栓后症状性颅内出血风险之间的可能关联。
