Factors Affecting the Occurence of Intracerebral Hemorrhage After Intravenous Recombinant Tissue Plasminogen Activator Therapy
Abstract
Objective: Intracerebral hemorrhage (ICH) is a potentially dangerous complication of thrombolytic therapy. Aim of this study was to evaluate factors that related with intracerebral hemorrhage after rtPA therapy.
Methods: This retrospective study analyzed patients with ischemic stroke who were treated with intravenous recombinant tissue plasminogen activator (rtPA) within 4.5 hours from symptom onset. Demographic data, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores at admission, symptom to needle time, size of infarction area, and blood tests results were retrieved to determine predictors of ICH.
Results: 211 patients fulfilled inclusion criteria with mean age of 66+/-12. 118 patients (55.9%) were male. The NIHSS score was 11 in median (1-30). The average symptom to needle time was 162+/-12 min (30-239). 39 patients (18.5%) had ICH, and of these 23 (58.9%) had symptomatic ICH and 14 (35.9%) of ICH patients had fatal outcome. This study showed higher blood pressure during first 24 hours after rtPA therapy and large infarction were statistically associated with ICH, p < 0.05 and p < 0.001, respectively. Other factors, blood pressure before administering intravenous rtPA, NIHSS score, symptom to needle time, and laboratory results were no significant difference.
Conclusions: High blood pressure level and large infarction can be used to predict ICH after thrombolysis. However, blood pressure is one factor that can be controlled during therapy. Reducing blood pressure especially during 24 hours below recommended level after intravenous rtPA therapy may be helpful to reduce ICH risk.
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