Boonrod Arunnit, Tangsakul Prompan, Kasemsap Narongrit, Vorasoot Nisa, Tiamkao Somsak, Sawanyawisuth Kittisak, Kongbunkiat Kannikar
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
BMJ Neurol Open. 2023 Sep 25;5(2):e000441. doi: 10.1136/bmjno-2023-000441. eCollection 2023.
Post thrombolytic symptomatic intracerebral haemorrhage (sICH) is a major concern in patients who had acute ischaemic stroke. Leukoaraiosis (LA) is reported to be related with sICH after intravenous thrombolytic treatment. However, the influence of LA and stroke neurological and imaging severity scores is still debated.
To evaluate if LA or severity scores are related with sICH in patients who had acute ischaemic stroke who received thrombolytic therapy. And, predictors for sICH were also studied with adjustment of baseline severity scores.
This was a retrospective, analytical study. The inclusion criteria were adult patients diagnosed as acute ischaemic stroke who received the recombinant tissue plasminogen activator (rtPA) treatment within 4.5 hours. The study period was between May 2007 and November 2016. Predictors for sICH were determined using logistic regression analysis.
During the study period, there were 504 eligible patients. Of those, 45 patients (8.92%) had sICH. Among nine factors in the final model for predicting sICH, there were four independent factors including previous antiplatelet therapy, previous anticoagulant therapy, presence of LA and hyperdense artery sign. The highest adjusted OR was previous anticoagulant therapy (5.08 with 95% CI of 1.18 to 11.83), while the LA factor had adjusted OR (95% CI) of 2.52 (1.01 to 6.30).
LA, hyperdense artery sign, previous antiplatelet therapy and previous anticoagulant therapy were associated with post-rtPA sICH. Further studies are required to confirm the results of this study.
溶栓后症状性脑出血（sICH）是急性缺血性脑卒中患者的主要担忧。据报道，白质疏松（LA）与静脉溶栓治疗后的sICH有关。然而，LA与卒中神经和影像学严重程度评分的影响仍存在争议。
评估LA或严重程度评分与接受溶栓治疗的急性缺血性脑卒中患者的sICH是否相关。并且，还在调整基线严重程度评分的情况下研究了sICH的预测因素。
这是一项回顾性分析研究。纳入标准为在4.5小时内接受重组组织型纤溶酶原激活剂（rtPA）治疗的成年急性缺血性脑卒中患者。研究期间为2007年5月至2016年11月。使用逻辑回归分析确定sICH的预测因素。
在研究期间，有504例符合条件的患者。其中，45例患者（8.92%）发生了sICH。在预测sICH的最终模型中的九个因素中，有四个独立因素，包括既往抗血小板治疗、既往抗凝治疗、LA的存在和高密度动脉征。调整后的最高比值比是既往抗凝治疗（5.08，95%CI为1.18至11.83），而LA因素的调整后比值比（95%CI）为2.52（1.01至6.30）。
LA、高密度动脉征、既往抗血小板治疗和既往抗凝治疗与rtPA后sICH相关。需要进一步研究来证实本研究的结果。
