Department of Neurology, Center of Cerebrovascular Disease, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Curr Neurovasc Res. 2020;17(4):344-353. doi: 10.2174/1567202617666200514114258.
Hemorrhagic transformation (HT) has an adverse effect on the prognosis of patients with acute ischemic stroke, and it is currently known associated with coagulation system. But the conclusion is not consistent and remains to be identified. The aim of this study was to investigate the association between coagulation function and spontaneous hemorrhagic transformation.
Patients within 7 days from the onset of ischemic stroke who did not receive reperfusion therapy (thrombolysis or endovascular treatment) were included between January 2016 and October 2017. Coagulation function indicators, including prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), thrombin time (TT) and fibrinogen (FIB), were tested within 24 h after admission. HT was defined as hemorrhage presented on follow-up magnetic resonance imaging (MRI) or computed tomography (CT) but not on baseline CT. We performed binary logistic regression to examine the association between coagulation function and HT. The coagulation indicators were entered into logistic regression analysis as continuous variables (per 1-unit/L increase) and four-categorized variables (with data collapsed into quartiles), respectively.
A total of 1141 patients were included (mean age, 64 ± 15 years; 63.7% males). 102 patients experienced HT (8.9%), of whom 14 patients experienced symptomatic HT (sHT, 1.2%). After adjustment for confounders, TT in the highest quartile is inversely associated with risk of HT (as continuous variable, odds ratio [OR] 0.85; 95% confidence level [CI] 0.73-0.99, P = 0.042; as four-categorized variable, OR 0.36, 95% CI 0.18 - 0.7, P = 0.003). Whether as continuous variables or four-categorized variables, PT, INR, APTT and FIB had no association with HT.
Not the whole process of coagulation function is associated with spontaneous HT. Prolonged TT, which may indicate an extension of the last step of the coagulation process, is independently and inversely associated with spontaneous HT in patients with acute ischemic stroke.
出血转化（HT）对急性缺血性脑卒中患者的预后有不良影响，目前已知与凝血系统有关。但结论并不一致，仍有待确定。本研究旨在探讨凝血功能与自发性出血转化的关系。
纳入 2016 年 1 月至 2017 年 10 月发病 7 天内未接受再灌注治疗（溶栓或血管内治疗）的缺血性脑卒中患者。入院后 24 小时内检测凝血功能指标，包括凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、国际标准化比值（INR）、凝血酶时间（TT）和纤维蛋白原（FIB）。HT 定义为随访磁共振成像（MRI）或计算机断层扫描（CT）上出现但基线 CT 上未出现的出血。我们采用二元逻辑回归分析来检测凝血功能与 HT 之间的关系。凝血指标分别作为连续变量（每增加 1 单位/L）和四分类变量（数据合并为四分位数）纳入逻辑回归分析。
共纳入 1141 例患者（平均年龄 64±15 岁，63.7%为男性）。102 例患者发生 HT（8.9%），其中 14 例患者发生症状性 HT（sHT，1.2%）。调整混杂因素后，TT 最高四分位数与 HT 风险呈负相关（作为连续变量，比值比[OR]0.85；95%置信区间[CI]0.73-0.99，P=0.042；作为四分类变量，OR0.36，95%CI0.18-0.7，P=0.003）。PT、INR、APTT 和 FIB 无论是作为连续变量还是四分类变量，与 HT 均无关联。
并非凝血功能的整个过程都与自发性 HT 有关。可能反映凝血过程最后一步延长的 TT 延长与急性缺血性脑卒中患者自发性 HT 独立且呈负相关。
