Neacă Ileana, Negroiu Cristina Elena, Tudorașcu Iulia, Dănoiu Raluca, Moise Cristiana Gianina, Toader Despina Manuela, Dănoiu Suzana
Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Sanocare Medical Center Craiova, 200061 Craiova, Romania.
Medicina (Kaunas). 2025 Apr 14;61(4):722. doi: 10.3390/medicina61040722.
: 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.
这是一项在罗马尼亚克拉约瓦县立临床医院进行的回顾性研究，为急性缺血性卒中（AIS）溶栓患者的出血性转化（HT）提供了有价值的见解。重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓后，出血性并发症仍然是一个重大问题。本研究旨在分析溶栓后与HT相关的临床和生物学因素。
对2020年1月至2024年12月期间在克拉约瓦县立临床医院接受rt-PA治疗的356例患者进行了回顾性分析。根据溶栓后24小时的CT表现，将患者分为三组：无HT、轻度HT和重度HT。分析了基线特征，包括人口统计学、病史、美国国立卫生研究院卒中量表（NIHSS）评分、影像学表现和实验室参数。采用方差分析和卡方检验进行统计分析，显著性阈值<0.05。
12.08%的患者发生了HT（轻度HT：8.15%，重度HT：3.93%）。重度HT组的死亡率（71.43%）显著高于轻度HT组（41.38%）和非HT组（13.42%）（<0.001）。较低的血小板计数（=0.003）、血糖升高（=0.004）、QT间期延长（=0.004）和纤维蛋白原水平降低（=0.005）与HT显著相关。其他危险因素包括心房颤动（=0.001）、高血压（=0.005）、门到针时间延迟（<0.001）、糖尿病（=0.007）、CT上的致密大脑中动脉（ACM）征（=0.003）、老年（<0.001）、肥胖（=0.001）、2小时/24小时早期神经功能恶化（<0.001）、谷草转氨酶升高（<0.001）、谷丙转氨酶升高（=0.002）、低密度脂蛋白胆固醇降低（<0.001）、总胆固醇降低（=0.001）和甘油三酯降低（<0.001）。
发生HT的患者临床结局较差，重度HT与最高死亡率相关。危险因素包括年龄、营养状况、高血糖以及低血小板和纤维蛋白原水平等。
