Prior Asymptomatic Parenchymal Hemorrhage Does Not Increase the Risk for Intracranial Hemorrhage after Intravenous Thrombolysis
Prior Asymptomatic Parenchymal Hemorrhage Does Not Increase the Risk for Intracranial Hemorrhage after Intravenous Thrombolysis
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DOI：
10.1159/000439141
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发表时间：
2015-01-01
影响因子：
2.9
通讯作者：
Sawyer, Robert
中科院分区：
文献类型：
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作者：
AbdelRazek, Mahmoud AbdelMageed;Mowla, Ashkan;Sawyer, Robert
背景资料：NINDS试验证实了静脉注射重组组织型纤溶酶原激活剂（rtPA）在改善急性缺血性卒中患者神经功能结局方面的疗效。有颅内出血（ICH）既往史的患者被排除在本试验之外，可能是由于假设后续出血风险增加。因此，无论是反对还是支持在既往ICH患者中使用IV rtPA的数据都很少。我们的目的是通过一项基于医院的回顾性单中心研究，帮助确定IV rtPA在此类患者中的安全性。研究方法：我们审查了2006年1月至2014年4月在综合卒中中心接受IV rtPA治疗的所有患者的脑成像，以获得IV rtPA给药时既往ICH的证据。根据NINDS试验定义的症状性ICH的后续发展确定其结局。结果：回顾性分析了640例患者的脑影像学资料。共有27例患者在静脉溶栓时显示出既往ICH的证据，均为脑实质内。仅1例患者（3.7%）在IV rtPA给药后发生后续症状性ICH。在其余613例接受IV rtPA治疗的患者中，25例患者（4.1%）发生症状性ICH。结论：这项回顾性研究提供了C级证据，证明有既往无症状脑实质内出血影像学证据的患者在出现急性缺血性卒中后，IV溶栓治疗后发生症状性ICH的风险并未增加。(C)2015 S. Karger AG，巴塞尔
Background: The NINDS trial demonstrated the efficacy of intravenous (IV) recombinant tissue plasminogen activator (rtPA) in improving the neurologic outcome in patients presenting with acute ischemic strokes. Patients who had a prior history of intracranial hemorrhage (ICH) were excluded from this trial, possibly due to a hypothetical increase in the subsequent bleeding risk. Thus, there is little data available, whether against or in favor of, the use of IV rtPA in patients with prior ICH. We aim to aid in determining the safety of IV rtPA in such patients through a retrospective hospital-based single center study. Methods: We reviewed the brain imaging of all patients who received IV rtPA at our comprehensive stroke center from January 2006 to April 2014 for evidence of prior ICH at the time of IV rtPA administration. Their outcomes were determined in terms of subsequent development of symptomatic ICH as defined by the NINDS trial. Results: Brain imaging for 640 patients was reviewed. A total of 27 patients showed evidence of prior ICH at the time of IV thrombolysis, all intra-parenchymal. Only 1 patient (3.7%) developed subsequent symptomatic ICH after the administration of IV rtPA. Of the remaining 613 patients who received IV rtPA, 25 patients (4.1%) developed symptomatic ICH. Conclusion: This retrospective study provides Level C evidence that patients with imaging evidence of prior asymptomatic intra-parenchymal hemorrhage presenting with an acute ischemic stroke do not show an increased risk of developing symptomatic ICH after IV thrombolysis. (C) 2015 S. Karger AG, Basel