Long-Term Outcomes of Post-Thrombolytic Intracerebral Hemorrhage in Ischemic Stroke Patients
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ORIGINAL ARTICLE
Long-Term Outcomes of Post-Thrombolytic Intracerebral Hemorrhage in Ischemic Stroke Patients Kiersten E. Norby • Farhan Siddiq • Malik M. Adil • Saqib A. Chaudhry • Adnan I. Qureshi
Published online: 5 December 2012 Ó Springer Science+Business Media New York 2012
Abstract Background Intracerebral hemorrhage (ICH) is an infrequent complication of intravenous recombinant tissue plasminogen activator (rt-PA) for the treatment of acute stroke. However, such ICH is an important reason for withdrawal of care because of lack of adequate data regarding long-term patient outcomes. Objective To report the long-term outcomes in patients with post-thrombolytic ICH. Methods We analyzed patient data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 h of symptom onset. Baseline clinical characteristics and outcomes defined by modified Rankin scale (mRS) were ascertained at 3, 6, and 12 months after treatment in patients who suffered from post-thrombolytic ICH. Favorable outcome was defined by mRS of 0–3 and unfavorable outcome by mRS of 4–6 at 1 year. Results A total of 48 patients suffered post-thrombolytic ICH in the trial. Fourteen patients had favorable outcomes and 34 patients had unfavorable outcomes. Clinical characteristics did not have an impact on patient outcomes at 12 months. Patients with unfavorable outcomes were more
K. E. Norby F. Siddiq Zeenat Qureshi Stroke Research Center, Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA K. E. Norby (&) Department of Surgery, 701 Park Ave S, Minneapolis, MN 55415, USA e-mail: [email protected] M. M. Adil S. A. Chaudhry A. I. Qureshi Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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likely to have an National Institutes of Health Stroke Scale (NIHSS) score C20 at 7–10 days after treatment (64 vs. 7 %, p < 0.0009). Patients with unfavorable outcomes were more likely to have a worsening of NIHSS score of >4 points at 7–10 days from their baseline NIHSS (44 vs. 0 %, p = 0.0006). Conclusion Approximately 30 % of patients with postthrombolytic ICH have favorable outcomes at 1 year which does not support early withdrawal of care. Ascertainment of NIHSS score and worsening of NIHSS score at 7–10 days may be necessary for accurate prognostic stratification. Keywords Intracerebral hemorrhage Ischemic stroke Thrombolytic Long-term outcome Modified Rankin score Barthel index
Introduction Intravenous recombinant tissue plasminogen activator (rt-PA) is the most commonly used treatment for eligible acute stroke patients [1, 2] that has shown to improve longterm functional outcomes [3]. Intracerebral hemorrhage (ICH) is an infrequent complication of intravenous rt-PA for the treatment of acute stroke. During October 2008 through December 2009, post-thrombolytic ICH was seen in 44 out of 602 (7.3 %) ischemic stroke patients who received IV rt-PA in Minnesota [4]. Radiographically, post-thrombolytic ICH presents as a w
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