Management of thrombolysis-associated symptomatic intracerebral hemorrhage.
Management of thrombolysis-associated symptomatic intracerebral hemorrhage.
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DOI：
10.1001/archneurol.2010.175
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发表时间：
2010-08
影响因子：
--
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
--
作者：
Goldstein, Joshua N.;Marrero, Marisela;Masrur, Shihab;Pervez, Muhammad;Barrocas, Alex M.;Abdullah, Abdul;Oleinik, Alexandra;Rosand, Jonathan;Smith, Eric E.;Dzik, Walter H.;Schwamm, Lee H.
症状性脑出血(SICH)是急性卒中溶栓治疗最严重的并发症。目前尚不清楚SICH患者在确诊后是否会继续出血，也没有确定最合适的治疗方法。我们对2003年4月1日至2007年12月31日期间使用GUDIONS-STROKE数据库前瞻性收集的GET进行了回顾性分析。复习放射学影像和所有使用的促凝剂。采用多变量Logistic回归分析确定与住院死亡率相关的因素。在研究期间2362例急性缺血性卒中患者中，接受静脉注射组织型纤溶酶原激活剂的311例患者中有19例(6.1%)发生SICH，72例接受动脉内溶栓治疗的患者中有2例(2.8%)发生SICH。SICH患者的住院死亡率显著高于非SICH患者(15/20[75.0]%对56/332[16.9%]，P<；.001)。20名患者中有11名(55.0%)接受了共病治疗：7名患者接受新鲜冰冻血浆治疗，5名患者接受冷沉淀治疗，4名患者接受植二酮(维生素K1)治疗，3名患者接受血小板治疗，1名患者接受氨基己酸治疗。住院死亡率的独立预测因素包括SICH(优势比，32.6；95%可信区间，8.8-120.2)，美国国立卫生研究院卒中评分增加(1.2；1.1-1.2)，老年(1.3；1.0-1.7)，动脉内溶栓(2.9；1.4-6)。凝血障碍的治疗与结果无关。持续出血(>；脑内出血量增加33%)在10例患者中有4例发生(40.0%)。在许多SICH患者中，溶栓后凝血障碍得不到治疗。我们发现40.0%的患者在确诊后继续出血，这表明有很大的机会进行干预。有必要进行多中心登记，以分析溶栓相关脑出血的处理和预后。
Symptomatic intracerebral hemorrhage (sICH) is the most devastating complication of thrombolytic therapy for acute stroke. It is not clear whether patients with sICH continue to bleed after diagnosis, nor has the most appropriate treatment been determined. We performed a retrospective analysis of our prospectively collected Get With the Guidelines–Stroke database between April 1, 2003, and December 31, 2007. Radiologic images and all procoagulant agents used were reviewed. Multivariable logistic regression was performed to identify factors associated with in-hospital mortality. Of 2362 patients with acute ischemic stroke during the study period, sICH occurred in 19 of the 311 patients (6.1%) who received intravenous tissue plasminogen activator and 2 of the 72 (2.8%) who received intra-arterial thrombolysis. In-hospital mortality was significantly higher in patients with sICH than in those without (15 of 20 [75.0]% vs 56 of 332 [16.9%], P<.001). Eleven of 20 patients (55.0%) received therapy for co-agulopathy: 7 received fresh frozen plasma; 5, cryoprecipitate; 4, phytonadione (vitamin K1); 3, platelets; and 1, aminocaproic acid. Independent predictors of inhospital mortality included sICH (odds ratio, 32.6; 95% confidence interval, 8.8–120.2), increasing National Institutes of Health Stroke Scale score (1.2; 1.1–1.2), older age (1.3; 1.0–1.7), and intra-arterial thrombolysis (2.9; 1.4–6.0). Treatment for coagulopathy was not associated with outcome. Continued bleeding (>33% increase in intracerebral hemorrhage volume) occurred in 4 of 10 patients with follow-up scans available (40.0%). In many patients with sICH after thrombolysis, coagulopathy goes untreated. Our finding of continued bleeding after diagnosis in 40.0% of patients suggests a powerful opportunity for intervention. A multicenter registry to analyze management of thrombolysis-associated intracerebral hemorrhage and outcomes is warranted.
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