Hemorrhagic transformation in acute ischemic stroke - Potential contributing factors in the European Cooperative Acute Stroke Study
Hemorrhagic transformation in acute ischemic stroke - Potential contributing factors in the European Cooperative Acute Stroke Study
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DOI：
10.1161/01.str.28.5.957
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发表时间：
1997-05-01
期刊：
影响因子：
8.3
通讯作者：
Bluhmki, E
中科院分区：
文献类型：
--
作者：
Larrue, V;vonKummer, R;Bluhmki, E
背景与目的近年来的研究表明，溶栓治疗对急性缺血性脑卒中患者可能是有益的。然而，该治疗也具有出血性转化（HT）的显著风险。本研究的目的是选择潜在的贡献者HT。方法我们提供了一个解释性分析欧洲急性卒中合作研究（ECASS）的数据。ECASS是一项多中心、安慰剂对照、随机试验，研究重组组织型纤溶酶原激活剂治疗缺血性卒中，在症状发作后6小时内进行，共纳入620例患者。根据CT表现将HT分为出血性梗死或脑实质出血。结果临床症状严重程度（OR = 2.5; 95%CI = 1.6 ~ 4.0）和CT扫描早期缺血性改变（OR = 3：5; 95%CI = 1.6 ~ 4.0）与临床症状严重程度（OR = 2.5; 95%CI = 1.6 ~ 4.0）相关。2.3至5.3）与出血性梗死的风险增加相关。年龄增长（以十年为单位）; OR，1.3; 95%CI，1.0至1.7）和重组组织型纤溶酶原激活剂（OR，3.6; 95%CI，2.1至6.1）治疗与脑实质出血的风险有关。结论由于所有潜在的促成因素入院后很容易辨别，他们应该被用来改善患者的选择到未来的研究。
Background and Purpose Recent studies suggest that thrombolytic therapy may be of benefit to patients with acute ischemic stroke. However, the treatment also carries a significant risk of hemorrhagic transformation (HT). The purpose of this study was to select potential contributors to HT.Methods We provide an explanatory analysis of the European Cooperative Acute Stroke Study (ECASS) data. ECASS was a multicenter, placebo-controlled, randomized trial of recombinant tissue plasminogen activator in ischemic stroke, within 6 hours of symptom onset, which enrolled 620 patients. HTs were classified into either hemorrhagic infarction or parenchymal hemorrhage according to their CT scan appearance. We used logistic regression analysis to select potential contributing factors to each type of HT.Results The severity of initial clinical deficit (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.6 to 4.0) and the presenceof early ischemic changes on CT scan (OR, 3:5; 95% CI. 2.3 to 5.3) were associated with increased risk of hemorrhagic infarction. Increasing age (in decades; OR, 1.3; 95% CI, 1.0 to 1.7) and treatment with recombinant tissue plasminogen activator (OR, 3.6; 95% CI, 2.1 to 6.1) were related to the risk of parenchymal hemorrhage.Conclusions Since all potential contributing factors are readily discernible upon hospital admission, they should be used to improve selection of patients into future studies.