Abstract WMP117: Patterns of All Bleeding Complications Associated with r-tPA Use-experience of an Acadamic Center in China

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hong Chang ◽  
Xiaojuan Wang ◽  
Yuchen Qiao ◽  
Jie Zhao ◽  
Haiqing Song
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Tissue Type ◽  
Bleeding Complications ◽  
High Systolic Blood Pressure ◽  
Gingival Bleeding ◽  
Hemorrhagic Event ◽  
Hemorrhagic Complications

Background and objective: Rapid administration of intravenous recombinant tissue-type plasminogen activator (rt-PA) is the standard treatment for patients with acute ischemic stroke (AIS). While hemorrhage represents as an important and unpredictable complication of thrombolytic treatment, few studies have specifically assessed the prevalence and predictors of bleeding complications among AIS patients in Asia. We assessed characteristics of hemorrhagic complications after intravenous thrombolysis in Chinese AIS patients. Methods: This single-academic-center study retrospectively evaluated 351 acute ischemic stroke patients who received rt-PA intravenously from April 2011 to April 2016. The occurrence and characteristics of any hemorrhagic complications, as well as their associated risk factors were recorded and summarized. Multivariate logistic regression was conducted to analyze significant predictors of bleeding. Results: 134 (38.1%) patients experienced one hemorrhagic event in one or more locations The top seven common sites were gingiva (49.3%), skin (18.3%), urinary system (10.4%), digestive tract (7.5%), intra-cranial cavity (7.5%), mouth (4.4%) and nasal cavity (2.2%). All the gingival bleeding occurred during 1 to 24 hours after thrombolysis and was the first sign of bleeding. Intracranial hemorrhage (both symptomatic and asymptomatic) occurred in 16 patients, of whom 4 presented first with gingival bleeding. Multivariate analysis showed that high systolic blood pressure (SBP) and National Institutes of Health Stroke Scale (NIHSS) score were independent risk factors for hemorrhage post thrombolysis (P<0.05). Conclusions: One out of three AIS patients in this study had a bleeding complication. The most common site of initial hemorrhage after intravenous thrombolysis was gingival, which frequently occurred as the initial bleeding site within 24 hours after thrombolysis. Consistent with literature, elevated SBP and higher NIHSS were the two key predictors of bleeding risk.

scholarly journals Characteristics of acute ischemic stroke in hospitalized patients in Tibet: a retrospective comparative study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuxuan Lu ◽  
Cidan Zhuoga ◽  
Haiqiang Jin ◽  
Feiqi Zhu ◽  
Yuhua Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Young Adult ◽  
Comparative Study ◽  
Acute Ischemic Stroke ◽  
High Altitude ◽  
Intravenous Thrombolysis ◽  
Categorical Variables ◽  
Anterior Circulation ◽  
Tibet Autonomous Region

Abstract Background Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing. Methods This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis. Results In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases. Conclusion In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

scholarly journals Intravenous thrombolysis in acute ischemic stroke patients with negative CT perfusion: a case series

2014 ◽  
Vol 3 (7) ◽  
pp. 204798161454321
Author(s):  
Ratnesh Mehra ◽  
Chiu Yuen To ◽  
Omar Qahwash ◽  
Boyd Richards ◽  
Richard D Fessler
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Stroke Patients ◽  
Radiographic Findings ◽  
Type Plasminogen Activator

Background Computed tomography perfusion (CTP) is a commonly used modality of neurophysiologic imaging to aid the selection of acute ischemic stroke patients for neuroendovascular intervention by identifying the presence of penumbra versus infarcted brain tissue. However many patients present with evidence of cerebral ischemia with normal CTP, and in that case, should intravenous thrombolytics be given? Purpose To demonstrate if tissue-type plasminogen activator (tPA)-eligible stroke patients without perfusion defects demonstrated on CTP would benefit from administration of intravenous thrombolytics. Material and Methods We retrospectively identified patients presenting with acute ischemic symptoms who received intravenous tPA (IV-tPA) from January to June 2012 without a perfusion defect on CTP. Clinical and radiographic findings including the NIHSS at presentation, 24 h, and at discharge, symptomatic and asymptomatic hemorrhagic transformation, and the modified Rankin score at 30 days were collected. A reduction of NIHSS of greater than 4 points or resolution of symptoms was considered significant. Results Seventeen patients were identified with a mean NIHSS of 8.2 prior to administration of intravenous thrombolytics, 3.5 after 24 h, and 2.5 at discharge. Among them, 13 patients had significant improvement of NIHSS with a mean reduction of 6.15 points at 24 h. One patient initially improved but had delayed hemorrhagic transformation and died. Two patients had improvement in NIHSS but were not significant and two patients had increased in NIHSS at 24 h, although one eventually improved at discharge. There was no asymptomatic hemorrhagic transformation. Mean mRS at 3 months is 1.76. Conclusion The failure to identify a perfusion deficit by CTP should not be used as a contraindication for intravenous thrombolytics. Criteria for administration of intravenous thrombolytics should still be based on time from symptom onset as previously published by NINDS.

Effects of SSRI exposure on hemorrhagic complications and outcome following thrombolysis in ischemic stroke

2017 ◽  
Vol 13 (5) ◽  
pp. 511-517 ◽  
Author(s):  
Christoph Schellen ◽  
Julia Ferrari ◽  
Wilfried Lang ◽  
Marek Sykora
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Ad Hoc ◽  
Binary Logistic Regression ◽  
Tissue Type ◽  
Bleeding Complications ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Hemorrhagic Complications

Background Selective serotonin reuptake inhibitors (SSRI) may interfere with platelet function, and pre-stroke SSRI treatment has been associated with increased hematoma volumes and mortality in hemorrhagic stroke patients. The effects of SSRI on the risk of hemorrhagic complications after thrombolysis in ischemic stroke patients are unclear. Aims To examine the effects of pre-stroke SSRI exposure on bleeding complications, functional outcome, and mortality following thrombolysis in ischemic stroke. Methods Data including standard demographic and clinical variables as well as baseline and follow-up stroke severity (measured by National Institutes of Health Stroke Score), functional outcome (measured by modified Rankin Scale) at 3 months, and mortality at 7 and 90 days were extracted from the Virtual International Stroke Trials Archive. Multivariable binary logistic regression was used for statistical analyses. Results Out of 1114 ischemic stroke patients treated with recombinant tissue-type plasminogen activator, 135 (12.1%) had previous SSRI exposure. Symptomatic intracranial hemorrhage occurred in 30 (2.7%) patients. Of those, 2 (1.5%, n = 135) were in the SSRI pretreatment group and 28 (2.9%, n = 979) were SSRI naive patients. Pre-stroke SSRI exposure in thrombolysed patients showed association with neither bleeding complications ( P = .58) nor functional outcome ( P = .38) nor mortality ( P = .65). Conclusions Results from this large retrospective ad hoc database cohort study indicate that pre-stroke SSRI exposure in ischemic stroke patients who receive thrombolytic treatment is not associated with bleeding complications, functional outcome, or mortality.

scholarly journals The risk factors of early hemorrhage after emergency intravenous thrombolysis in patients with acute ischemic stroke

2021 ◽  
Vol 10 (5) ◽  
pp. 5706-5713
Author(s):  
Xuemei Zhang ◽  
Yawei Yu ◽  
Lijuan Jiang ◽  
Tiantian Chen ◽  
Yan Sang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis

scholarly journals Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

2020 ◽  
Author(s):  
Yuxuan Lu ◽  
Cidan Zhuoga ◽  
Haiqiang Jin ◽  
Feiqi Zhu ◽  
Yuhua Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Young Adult ◽  
Comparative Study ◽  
Acute Ischemic Stroke ◽  
High Altitude ◽  
Intravenous Thrombolysis ◽  
Categorical Variables ◽  
Anterior Circulation ◽  
Tibet Autonomous Region

Abstract Background: Lots of studies of acute ischemic stroke (AIS) had been conducted at low altitude regions, and related findings were used to instruct clinic management while corresponding studies at high altitude were few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing. Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases. Conclusion: In Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

scholarly journals Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study

2020 ◽  
Author(s):  
Yuxuan Lu ◽  
Cidan Zhuoga ◽  
Haiqiang Jin ◽  
Feiqi Zhu ◽  
Yuhua Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Young Adult ◽  
Comparative Study ◽  
Acute Ischemic Stroke ◽  
High Altitude ◽  
Intravenous Thrombolysis ◽  
Categorical Variables ◽  
Anterior Circulation ◽  
Tibet Autonomous Region

Abstract Background: Numerous studies of acute ischemic stroke (AIS) have been conducted at low altitude regions, and the related findings were used to instruct clinic management while corresponding studies at high altitude are few. This study aimed to analyse AIS clinic characteristics at high altitude regions by conducting a hospital-based comparative study between Tibet and Beijing. Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1st January 2014, and 31st December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). PHOTAR groups also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and here young adults accounted for a larger proportion of stroke cases. Conclusion: In Tibet, the average age of AIS patients were less, and anterior circulation infarctions were also more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.

Abstract T P19: “Futile” Interhospital Transfer for Endovascular Recanalization Treatment in Acute Ischemic Stroke. The Madrid Stroke Network

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Blanca Fuentes ◽  
Maria Alonso de Leciñana ◽  
Alvaro Ximenez-Carrillo ◽  
Patricia Martínez-Sánchez ◽  
Antonio Cruz-Culebras ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Vascular Risk Factors ◽  
Stroke Onset ◽  
Vascular Risk ◽  
Interhospital Transfer ◽  
Hospital Transfer ◽  
Arterial Recanalization

Objectives: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke (IS) and the small number of patients eligible for that treatment justifies the development of Stroke Center networks with interhospital transfer of eligible patients. But it is possible that this approach generate “futile“ transfers (i.e. shift of patients who finally do not receive ET) generating unnecessary costs. Our aim is to analyze the frequency of “futile” transfers, the reasons for rejection for ERT and to identify the possible associated factors. Methods: We analyzed a prospective registry of ERT from a Stroke Network integrated by three hospitals with facilities for ERT for acute stroke patients. These hospitals share a common stroke protocol and have established a weekly rotatory shift with inter-hospital transference to the on-call center for ERT in those patients in whom this therapy is indicated, both primarily, after completing IV thrombolysis or in patients attended in outside hospitals (drip and shift). We analyzed: demographic data, vascular risk factors, stroke severity, frequency of prior intravenous thrombolysis, time from stroke onset and reasons for rejection. Study period: 1/02/2012 to 07/05/2013. Results: ERT protocol was activated in 199 patients, receiving ERT 129 (64.8%). 120 (60.3%) patients required inter-hospital transfer, among them 50 (41%) were not finally treated (futile transfer). These were more often male (74.1% vs. 25.9%, P = 0.04), with no differences in age, vascular risk factors, time-lapse from stroke onset or delay of inter-hospital transfer, baseline NIHSS, baseline ASPECTS or rate of prior intravenous thrombolysis between transferred patients treated with ERT and those non-treated. Reasons for rejection were: clinical improvement (16%), arterial recanalization (24%), clinical deterioration (8%); ASPECTS <7 in the 2nd TC (20%), absence of mismatch (20%); delay in shipment (2%), revocation of consent (1%). Conclusions: 40% of shipments for ERT are “futile”. None of the baseline patient characteristics predict this fact, being arterial recanalization and findings in a second imaging test done in the receiving hospital the main reasons for ERT rejection.

scholarly journals Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

2020 ◽  
Vol 17 (2) ◽  
pp. 618 ◽  
Author(s):  
Yi-Ju Tseng ◽  
Ru-Fang Hu ◽  
Shin-Tyng Lee ◽  
Yu-Li Lin ◽  
Chien-Lung Hsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Outcomes ◽  
Plasminogen Activator ◽  
Tissue Type ◽  
Hospital Death ◽  
Factors Associated ◽  
Laboratory Test Results ◽  
Poor Outcomes

Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.

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