Liu Sihan, Gao Jiadi, Zhao Hanshu, Xu Yuanqi, Zhou Yubing, Liu Yushuang, Shen Jinru, Zhang Zhongling
Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
SAGE Open Med. 2024 Sep 29;12:20503121241283881. doi: 10.1177/20503121241283881. eCollection 2024.
The relationship between blood pressure variability and hemorrhagic transformation after recombinant tissue plasminogen activator thrombolysis in patients with acute ischemic stroke is uncertain due to inconsistent methodologies across studies. This study aimed to elucidate the association between 24-h systolic blood pressure extremes post-admission and hemorrhagic transformation while considering the possibility of hemorrhagic transformation occurring beyond the initial monitoring period.
We enrolled patients admitted to The First Affiliated Hospital of Harbin Medical University for ischemic stroke who were treated with intravenous recombinant tissue plasminogen activator within 4.5 h of symptom onset between January 2020 and December 2022. We analyzed the relationships among admission blood pressure, 24-h post-admission recombinant tissue plasminogen activator (mean, maximum, minimum, extreme difference, standard deviation, and coefficient of variation), immediate and 1-h post-thrombolysis blood pressure, and hemorrhagic transformation occurrence within 36 h post-thrombolysis. The potential for delayed hemorrhagic transformation was also considered during the interpretation of the results.
Among the 138 patients, 39.1% experienced post-thrombolytic hemorrhagic transformation. Multivariate analysis revealed that hemorrhagic transformation was significantly associated with coronary artery disease, cerebral leukoaraiosis, large cerebral infarction, elevated random glucose levels, and 24-h systolic blood pressure extremes at admission. Specifically, 24-h systolic blood pressure extremes showed a significant positive correlation with hemorrhagic transformation (OR = 1. 042; 95% CI: 1.000-1.086, < 0.05).
These findings underscore the importance of establishing robust protocols for continuous blood pressure monitoring and intervention strategies tailored to individual risk profiles. Given that hemorrhagic transformation can occur beyond the initial 36 h, clinicians should maintain vigilance for delayed hemorrhagic transformation, particularly in patients with high recombinant tissue plasminogen activator. Strict control of blood pressure, especially minimizing extremes in systolic blood pressure, is essential to ensure the safety of patients undergoing thrombolysis.
由于各研究方法不一致，急性缺血性脑卒中患者接受重组组织型纤溶酶原激活剂溶栓后血压变异性与出血转化之间的关系尚不确定。本研究旨在阐明入院后24小时收缩压极值与出血转化之间的关联，同时考虑出血转化在初始监测期后发生的可能性。
我们纳入了2020年1月至2022年12月期间在哈尔滨医科大学附属第一医院因缺血性脑卒中入院、症状发作后4.5小时内接受静脉重组组织型纤溶酶原激活剂治疗的患者。我们分析了入院血压、入院后24小时重组组织型纤溶酶原激活剂（平均值、最大值、最小值、极差、标准差和变异系数）、溶栓后即刻和1小时血压与溶栓后36小时内出血转化发生情况之间的关系。在结果解释过程中也考虑了延迟出血转化的可能性。
138例患者中，39.1%发生了溶栓后出血转化。多变量分析显示，出血转化与冠状动脉疾病、脑白质疏松症、大面积脑梗死、随机血糖水平升高以及入院时24小时收缩压极值显著相关。具体而言，24小时收缩压极值与出血转化呈显著正相关（OR = 1.042；95%CI：1.000 - 1.086，P < 0.05）。
这些发现强调了建立稳健的持续血压监测方案以及根据个体风险状况制定干预策略的重要性。鉴于出血转化可能在最初36小时后发生，临床医生应警惕延迟出血转化，尤其是在接受重组组织型纤溶酶原激活剂治疗的患者中。严格控制血压，尤其是尽量减少收缩压的极值，对于确保溶栓患者的安全至关重要。
