Prediction factors and clinical significance of different types of hemorrhagic transformation after intravenous thrombolysis

Abstract

Abstract Background and purpose Hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in acute ischemic stroke seriously affects the prognosis of patients. This study aimed to investigate the risk factors of different types of HT and their correlation with prognosis after IVT.Methods Based on the CASE II registry, we included patients with acute ischemic stroke who received IVT within 4.5 hours of onset. HT was further divided into hemorrhagic infarction (HI) and parenchymal hemorrhage (PH). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3 to 6 at 3 months. Multivariate logistic regression analysis was used to determine the independent influencing factors of HT subtypes and clinical outcome.Results Among 13108 included patients, 541 patients (4.1%) developed HI and 440 (3.4%) developed PH. In multivariate analysis, age (OR 1.038, 95%CI 1.028 to 1.049,p < 0.001), atrial fibrillation (OR 1.446, 95%CI 1.141 to 1.943, P = 0.002), baseline diastolic pressure (OR 1.012, 95%CI 1.004 to 1.020, p = 0.005), baseline NIHSS score (OR 1.060, 95%CI 1.049 to 1.071, p < 0.001) and onset to treatment time (OTT) (OR 1.002, 95%CI 1.000 to 1.004, p = 0.020) independently predicted PH 24 hours after IVT. In the patients with HT, PH (OR 3.611, 95%CI 2.540 to 5.134, p < 0.001) and combination with remote hemorrhage (OR 1.579, 95%CI 1.115 to 2.235, p = 0.010) were independently related with poor outcome after IVT.Conclusions Different types of hemorrhagic transformation after IVT had different risk factors and clinical significance. The occurrence of PH and remote hemorrhage independently increased the risk of poor outcome.