Risk Factors of Intracerebral Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in Buriram Hospital
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Abstract
Background: Stroke is the most common neurological disease which is ranked as the second leading cause of death for people above 60 years and leads to disability. Intravenous recombinant tissue plasminogen activator (rtPA) treatment administered between 3-4.5 hours after the onset of symptoms significantly improved clinical outcomes. However, intravenous rtPA can cause a potential complication of intracerebral hemorrhage (ICH) leading to death or severe disability.
Objective: To study the risk factors of ICH after intravenous thrombolysis in acute stroke patients.
Methods: A prognostic factor research using retrospective observational cohort designwas conducted at the Department of Medicine, Buriram Hospital. The study samples were ischemic stroke patients who received intravenous rtPA between January 2016 to October 2020. The data of acute stroke patients treated with intravenousrtPA was collected. The patients’ characteristics, results of laboratory and brain computed tomography(CT) scan were compared between two groups: ICH and no ICH patients. The multivariable logistic regression was used to analyze the risk factors of ICH.
Results: Among 655 patients, 15.4% of patients had ICH (asymptomatic ICH 7.3% and symptomatic ICH 8.1%). The mean age was 64 years, 51.6% were male, and mean NIHSS score was 11. The risk factors of ICH included Largeartery atherosclerosis (odds ratio, 6.80; 95%CI 1.57-29.45; p=0.010), Cardioembolism (odds ratio, 12.40; 95%CI 2.83-54.40; p=0.001), Other etiologies (odds ratio, 18.86; 95%CI 2.24-159.03; p=0.007), and early infarction in CT brain (odds ratio, 2.98; 95%CI 1.75-5.09; p<0.001). There was no statistically significant difference based on age, hyperlipidemia, systolic blood pressure, NIHSS score,and platelet count.
Conclusion: Patient counseling should be provided to the patients with acute stroke caused by the Large artery atherosclerosis, Cardioembolism, and Other etiologies including the patients with CT brain show early infarction in order to explain the risks of ICH following the treatment with intravenous rtPA. The close monitoring was recommended in these groups of patients.
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