Analysis Of Risk Factors For Hemorrhage Transformation After Intravenous Thrombolysis

Objective Evaluating the risk factors of hemorrhage transformation(HT) after intravenous thrombolysis.Material and Methods It was a retrospective study from August 2016 to February2019.We included 43 patients of our hospital,treated by the intravenous thrombolytic therapy,rt-PA,for acute cerebral ischemic infarction.According to the brain imaging control during their hospitalization,these patients were divided in two groups: a control group without HT(36 cases)and a HT group(7 cases).All patients underwent a cerebral CT 24 hours post-rt-PA.A cerebral MRI/CT was also performed before their discharge.If neurological deterioration occurred during the hospitalization with NIHSS ≥ 4 points,a cerebral CT was performed immediately.The data showed : 7 cases in HT group(70.1± 9.2 years,4 males and 3 females)with NIHSS score(11.57 ± 5.20);36 cases in HT group(66.2 ± 10.5 y),21 males and 15 females)with NIHSS score(6.56 ± 5.68).In order to evaluate the risk factors of HT,we collected basic data of our participants:gender,age,smoking history,hypertension,diabetes,atrial fibrillation/flutter,and history of cerebral ischemic stroke.The imaging data includes the degree of leukoaraiosis on CT,unilateral middle cerebral artery densification sign on CT,extensive cerebral infarction,and early ischemic changes before thrombolysis.The biochemical data include TG(triglyceride),CH(cholesterol),LDL(low density lipoprotein),HDL(high density lipoprotein),HCY(homocysteine),Hb A1c(glycated hemoglobin),BUN(urea nitrogen),CRE(creatinine),INR,APTT,FIB.Other data were also acquired: NIHSS score and blood pressure before and after thrombolysis,whether there was hemorrhage in other parts during thrombolysis,whether there was a neurological deterioration during thrombolysis(NIHSS ≥ 4),and the time from symptoms onset to thrombolysis.These 29 basic parameters underwent a single variable analysis to determine related causes of the HT.The variables with a P <0.05 were then analyzed by multivariate logistic regression to identify the risk factors for HT in AIS patients post rt-PA intravenous thrombolysis.Results This study showed that the incidence of HT after thrombolysis was 16.28%.Univariate analysis showed that the relation between HT and large-area cerebral infarction(P = 0.032),the time from onset to thrombolysis(P = 0.009),early CT ischemic changes(P = 0.005),moderate to severe leukoaraiosis(P = 0.02)and unilateral middle cerebral artery densification sign(P = 0)were statistically significant.Using the HT after intravenous thrombolysis as the dependent variable,the above variables with statistical differences were used as independent variables,multiple logistic regression analysis was performed.The results showed that a moderate to severe leukoaraiosis(OR= 10.73,P = 0.04),and the unilateral middle cerebral artery densification sign(OR =61.18,P = 0.02)were two independent risk factors for hemorrhagic transformation in thrombolytic patients(P <0.05).Conclusion In the treatment of intravenous thrombolysis,the selection of thrombolysable patients needs to consider a variety of factors.If patient’s cerebral image suggests a moderate to severe leukoaraiosis and unilateral middle cerebral artery densification which are independent risk factors for hemorrhagic transformation,it might require more cautions in intravenous thrombolysis therapy.