Modrego Pedro J
Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Ann Indian Acad Neurol. 2019 Jul-Sep;22(3):336-340. doi: 10.4103/aian.AIAN_323_18.
Thrombolysis is the standard of treatment for acute ischemic stroke, with a time window of up to 4½ h from stroke onset. Despite the long experience with the use of recombinant tissue plasminogen activator and the adherence to protocols symptomatic intracranial hemorrhage (SICH) may occur in around 6% of cases, with high-mortality rate and poor-functional outcomes. Many patients are excluded from thrombolysis on the basis of an evaluation of known risk factors, but there are other less known factors involved.
The purpose of this work is to analyze the less known risk factors for SICH after thrombolysis. A search of articles related with this field has been undertaken in PubMed with the keywords (brain hemorrhage, thrombolysis, and acute ischemic stroke). Some risk factors for SICH have emerged such as previous microbleeds on brain magnetic resonance imaging, leukoaraiosis, and previous antiplatelet drug use or statin use. Serum matrix metalloproteinases have emerged as a promising biomarker for better selection of patients, but further research is needed.
In addition to the already known risk factors considered in the standard protocols, an individualized evaluation of risks is needed to minimize the risk of brain hemorrhage after thrombolysis for ischemic stroke.
溶栓是急性缺血性卒中的标准治疗方法，时间窗为卒中发作后长达4.5小时。尽管使用重组组织型纤溶酶原激活剂已有很长时间的经验，且严格遵循方案，但仍有大约6%的病例可能发生症状性颅内出血（SICH），其死亡率高且功能预后差。许多患者基于对已知危险因素的评估而被排除在溶栓治疗之外，但还存在其他一些鲜为人知的因素。
这项工作的目的是分析溶栓后发生SICH的鲜为人知的危险因素。在PubMed上以（脑出血、溶栓和急性缺血性卒中）为关键词搜索了与该领域相关的文章。已出现一些SICH的危险因素，如脑磁共振成像上先前的微出血、脑白质疏松症以及先前使用抗血小板药物或他汀类药物。血清基质金属蛋白酶已成为一种有前景的生物标志物，可用于更好地选择患者，但仍需进一步研究。
除了标准方案中已考虑的已知危险因素外，还需要进行个体化的风险评估，以将缺血性卒中溶栓后脑出血的风险降至最低。
