Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score.

Abstract

BACKGROUND AND PURPOSE:

Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH.

METHODS:

We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score.

RESULTS:

We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70.

CONCLUSIONS:

The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.

• Authors: Michael Mazya, José A Egido, Gary A Ford, Kennedy R Lees, Robert Mikulik, Danilo Toni, Nils Wahlgren, Niaz Ahmed, SITS Investigators
• Journal: Stroke (Stroke) Vol. 43 Issue 6 Pg. 1524-31 (Jun 2012) ISSN: 1524-4628 [Electronic] United States
• PMID: 22442178 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Platelet Aggregation Inhibitors
• Clopidogrel
• Tissue Plasminogen Activator
• Ticlopidine
• Aspirin

Topics

• Age Factors
• Aged
• Aspirin (administration & dosage, adverse effects)
• Body Weight
• Brain Ischemia (drug therapy, mortality)
• Cerebral Hemorrhage (chemically induced, mortality)
• Clopidogrel
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Hypertension (drug therapy, mortality)
• Injections, Intravenous
• Logistic Models
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Predictive Value of Tests
• Registries
• Risk Factors
• Stroke (drug therapy, mortality)
• Ticlopidine (administration & dosage, adverse effects, analogs & derivatives)
• Tissue Plasminogen Activator (administration & dosage, adverse effects)