Risk Factors and Outcomes of Hemorrhagic Transformation in Acute Ischemic Stroke Following Thrombolysis: Analysis of a Single-Center Experience and Review of the Literature.

: This is a retrospective study conducted at the Clinical County Hospital of Craiova, Romania, providing valuable insights into hemorrhagic transformation (HT) in thrombolyzed patients with acute ischemic stroke (AIS). Hemorrhagic complications remain a significant concern after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). This study aims to analyze clinical and biological factors associated with HT following thrombolysis. : A retrospective analysis was conducted on 356 patients who received rt-PA at the Clinical County Hospital of Craiova between January 2020 and December 2024. Patients were divided into three groups based on CT findings at 24 h post-thrombolysis: no HT, minimal HT, and massive HT. Baseline characteristics were analyzed, including demographics, medical history, NIHSS scores, imaging findings, and laboratory parameters. Statistical analysis was performed using ANOVA and chi-square tests, with a significance threshold of < 0.05. : HT occurred in 12.08% of patients (minimal HT: 8.15%, massive HT: 3.93%). Mortality was significantly higher in the massive HT group (71.43%) compared to minimal HT (41.38%) and non-HT (13.42%) ( < 0.001). Lower platelet count ( = 0.003), elevated blood glucose ( = 0.004), prolonged QT interval ( = 0.004), and reduced fibrinogen levels ( = 0.005) were significantly associated with HT. Other risk factors included atrial fibrillation ( = 0.001), hypertension ( = 0.005), delayed door-to-needle time ( < 0.001), diabetes mellitus ( = 0.007), dense ACM sign on CT ( = 0.003), older age ( < 0.001), obesity ( = 0.001), early neurological deterioration at 2 h/24 h ( < 0.001), elevated GOT ( < 0.001), elevated GPT ( = 0.002), lower LDL cholesterol ( < 0.001), lower total cholesterol ( = 0.001), and lower triglycerides ( < 0.001). : Patients with HT had worse clinical outcomes, with massive HT associated with the highest mortality. Risk factors include age, nutritional status, hyperglycemia, and low platelet and fibrinogen levels, among others.