Risk Factors Of Intracranial Hemorrhage In Patients With Acute Cerebral Infarction After Intravenous Alteplase Thrombolysis Within 24 Hours

As China gradually steps into the aging society,the number of the elderly population has increased sharply.Cerebral vascular disease--stroke,as the second leading cause of human death(it,together with heart disease and malignant tumor,constitute three fatal human diseases),It does great harm to the health and life of middle-aged and elderly people,and brings heavy burden and pain to patients,families and society.Acute cerebral infarction is the most common cerebrovascular disease and also a common critical and severe disease in neurology.Intravenous thrombolysis with rt-PA(recombinant tissue-type plasminogen activator)significantly improves the odds of good outcome after ischemic stroke when delivered within 4.5 hours of stroke onset,irrespective of age and over a broad range of stroke severity.Therefore,in the absence of contraindications,IVT is the standard therapy for all patients presenting with an acute ischemic stroke(AIS)within 4.5 hours after symptom onset.However,the risk of hemorrhagic transformation(HT)was increased when we intravenous thrombolysis with rt-PA.Hemorrhage transformation after cerebral infarction refers to intracerebral hemorrhage after acute ischemic stroke,and the imaging manifestations are scattered or localized high-density shadows in the original low-density infarction.HT includes symptomatic intracranial hemorrhage(sICH)and cerebral parenchymal hemorrhage,both of which are associated with adverse outcomes after intravenous thrombolysis.As one of the main complications of cerebral infarction,the incidence of HT is about 10% ~ 40%,which is closely related to the high disability rate and high mortality rate of patients with cerebral infarction.HT usually occurs within 24 to 36 hours after thrombolysis,leading to aggravation or death of patients with cerebral infarction,and bringing heavy burden to families and society.Even asymptomatic HT may have adverse effects on the prognosis of patients,so hemorrhagic transformation after thrombolysis has always been the focus of clinicians.ObjectiveThrough the analysis of the clinical data of patients diagnosed with acute cerebral infarction and intravenous rt-PA thrombolysis in our hospital,the risk factors of hemorrhagic transformation after rt-PA intravenous thrombolysis within 24 hours in patients with acute cerebral infarction were preliminarily discussed,so as to clarify the predictive indicators of HT.MethodSixty patients with acute cerebral infarction and rt-PA intravenous thrombolysis who were admitted to jiangxi provincial people’s hospital from August 2015 to April were included in this study.All of them were treated with intravenous rt-PA thrombolysis within the treatment time window,and no contraindication of intravenous thrombolysis was observed.Meanwhile,all of them met the conditions for intravenous thrombolysis and signed the informed consent for intravenous thrombolysis.They were divided into two groups(HT group and non-HT group),according to whether the head had intracranial hemorrhage or not after 24 hours of intravenous thrombolysis.Collect all the patients with acute cerebral infarction clinical features(including gender,age,time of onset,mRS score at admission,NIHSS score before thrombolysis,NIHSS score after thrombolysis,NIHSS score after thrombolysis 24 hours,previous history,family history,infarct site,infarct area,systolic blood pressure before thrombolysis,diastolic blood pressure before thrombolysis),laboratory tests(White blood cells before thrombolysis,Percentage of neutrophils before thrombolysis)and imaging(Head CT.The head of MRI),all the data were counted and analyzed,to analyze the risk factors of hemorrhage transformation after intravenous rt-PA thrombolysis within 24 hours in patients with acute cerebral infarction.ResultThe results showed that atrial fibrillation,within 3-hour thrombolysis time window,massive cerebral infarction,NIHSS score before thrombolysis,NIHSS score after thrombolysis,NIHSS score after thrombolysis 24 hours,and percentage of neutrophils before thrombolysis were risk factors for HT after rt-PA thrombolysis within 24 hours in patients with acute cerebral infarction.On the basis of single factor analysis,in order to further determine the effect and extent of influence factors in the patients with acute cerebral infarction,Logistic regression analysis was carried out with HT as a dependent variable.The results showed that the variables of statistical significance into the regression equation(P<0.05)were large area cerebral infarction and percentage of neutrophils before thrombolysis.This suggests that large area cerebral infarction and high percentage of neutrophils before thrombolysis are independent risk factors for hemorrhage transformation after intravenous rt-PA thrombolysis within 24 hours in patients with acute cerebral infarction.ConclusionHemorrhagic transformation after intravenous rt-PA thrombolysis is common in patients with acute cerebral infarction.Large area cerebral infarction and high percentage of neutrophils before thrombolysis are independent risk factors for hemorrhage transformation after intravenous rt-PA thrombolysis in patients with acute cerebral infarction.Therefore,patients with large cerebral infarction and high percentage of neutrophils before thrombolysis should be highly alert to the risk of intracranial hemorrhage after intravenous rt-PA thrombolysis within 24 hours.