Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: The multicenter rt-PA acute stroke survey

David Tanne, Scott E. Kasner, Andrew M. Demchuk, Nira Koren-Morag, Sandra Hanson, Martin Grond, Steven R. Levine, S. A. Hamilton, S. K. Hanson, M. Grond, J. C. Grotta, L. Morgenstern, D. Krieger, S. E. Kasner, C. Villar, D. Chiu, T. Wein, S. Hickenbottom, R. Felberg, A. M. DemchukA. M. Buchan, A. M. Demchuk, P. Barber, N. Newcommon, V. E. Bates, K. Vereczkey-Porter, S. E. Kasner, J. C. Chalela, M. L. McGarvey, D. Z. Wang, J. DeCampo, L. R. Wechsler, J. R. Binder, D. Book, D. Tanne, S. Daley, M. J. Gorman, P. Mitsias, C. A. Lewandowski, S. R. Levine, J. L. Frey, H. Jahnke, R. Zweifler, N. Koscicki, S. Cruz-Flores, Piero Verro, G. Tiejen, J. M. Lee, T. Lowenkopf, B. B. Worrall, K. C. Johnston, P. Fayad, J. Boiser, T. Giancarlo, A. Schuster, K. J. Becker, P. N. Karanjia, A. Shuaib, P. Kochanski, P. Scott, S. Wehner, J. M. Dayno, R. Bell, C. Benesch, W. M. Coplin, S. Chaturvedi, D. Dulli, M. A. Kalafut, C. S. Kidwell, J. L. Saver, D. Tanne, S. Daley, L. Salowich-Palm, L. R. Schultz, L. D'Olhaberriague, S. R. Levine

Research output: Contribution to journalArticle

332 Citations (Scopus)

Abstract

Background - Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH. Methods and Results - In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH. Conclusions - Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.

Original languageEnglish (US)
Pages (from-to)1679-1685
Number of pages7
JournalCirculation
Volume105
Issue number14
DOIs
StatePublished - Apr 9 2002
Externally publishedYes

Fingerprint

Cerebral Hemorrhage
Tissue Plasminogen Activator
Stroke
Therapeutics
Diabetes Mellitus
Platelet Aggregation Inhibitors
Middle Cerebral Artery
Surveys and Questionnaires
Platelet Count
Hematoma
Aspirin
Heart Diseases
Blood Pressure
Glucose
Serum

Keywords

  • Hemorrhage
  • Plasminogen activators
  • Stroke

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice : The multicenter rt-PA acute stroke survey. / Tanne, David; Kasner, Scott E.; Demchuk, Andrew M.; Koren-Morag, Nira; Hanson, Sandra; Grond, Martin; Levine, Steven R.; Hamilton, S. A.; Hanson, S. K.; Grond, M.; Grotta, J. C.; Morgenstern, L.; Krieger, D.; Kasner, S. E.; Villar, C.; Chiu, D.; Wein, T.; Hickenbottom, S.; Felberg, R.; Demchuk, A. M.; Buchan, A. M.; Demchuk, A. M.; Barber, P.; Newcommon, N.; Bates, V. E.; Vereczkey-Porter, K.; Kasner, S. E.; Chalela, J. C.; McGarvey, M. L.; Wang, D. Z.; DeCampo, J.; Wechsler, L. R.; Binder, J. R.; Book, D.; Tanne, D.; Daley, S.; Gorman, M. J.; Mitsias, P.; Lewandowski, C. A.; Levine, S. R.; Frey, J. L.; Jahnke, H.; Zweifler, R.; Koscicki, N.; Cruz-Flores, S.; Verro, Piero; Tiejen, G.; Lee, J. M.; Lowenkopf, T.; Worrall, B. B.; Johnston, K. C.; Fayad, P.; Boiser, J.; Giancarlo, T.; Schuster, A.; Becker, K. J.; Karanjia, P. N.; Shuaib, A.; Kochanski, P.; Scott, P.; Wehner, S.; Dayno, J. M.; Bell, R.; Benesch, C.; Coplin, W. M.; Chaturvedi, S.; Dulli, D.; Kalafut, M. A.; Kidwell, C. S.; Saver, J. L.; Tanne, D.; Daley, S.; Salowich-Palm, L.; Schultz, L. R.; D'Olhaberriague, L.; Levine, S. R.

In: Circulation, Vol. 105, No. 14, 09.04.2002, p. 1679-1685.

Research output: Contribution to journalArticle

Tanne, D, Kasner, SE, Demchuk, AM, Koren-Morag, N, Hanson, S, Grond, M, Levine, SR, Hamilton, SA, Hanson, SK, Grond, M, Grotta, JC, Morgenstern, L, Krieger, D, Kasner, SE, Villar, C, Chiu, D, Wein, T, Hickenbottom, S, Felberg, R, Demchuk, AM, Buchan, AM, Demchuk, AM, Barber, P, Newcommon, N, Bates, VE, Vereczkey-Porter, K, Kasner, SE, Chalela, JC, McGarvey, ML, Wang, DZ, DeCampo, J, Wechsler, LR, Binder, JR, Book, D, Tanne, D, Daley, S, Gorman, MJ, Mitsias, P, Lewandowski, CA, Levine, SR, Frey, JL, Jahnke, H, Zweifler, R, Koscicki, N, Cruz-Flores, S, Verro, P, Tiejen, G, Lee, JM, Lowenkopf, T, Worrall, BB, Johnston, KC, Fayad, P, Boiser, J, Giancarlo, T, Schuster, A, Becker, KJ, Karanjia, PN, Shuaib, A, Kochanski, P, Scott, P, Wehner, S, Dayno, JM, Bell, R, Benesch, C, Coplin, WM, Chaturvedi, S, Dulli, D, Kalafut, MA, Kidwell, CS, Saver, JL, Tanne, D, Daley, S, Salowich-Palm, L, Schultz, LR, D'Olhaberriague, L & Levine, SR 2002, 'Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: The multicenter rt-PA acute stroke survey', Circulation, vol. 105, no. 14, pp. 1679-1685. https://doi.org/10.1161/01.CIR.0000012747.53592.6A
Tanne, David ; Kasner, Scott E. ; Demchuk, Andrew M. ; Koren-Morag, Nira ; Hanson, Sandra ; Grond, Martin ; Levine, Steven R. ; Hamilton, S. A. ; Hanson, S. K. ; Grond, M. ; Grotta, J. C. ; Morgenstern, L. ; Krieger, D. ; Kasner, S. E. ; Villar, C. ; Chiu, D. ; Wein, T. ; Hickenbottom, S. ; Felberg, R. ; Demchuk, A. M. ; Buchan, A. M. ; Demchuk, A. M. ; Barber, P. ; Newcommon, N. ; Bates, V. E. ; Vereczkey-Porter, K. ; Kasner, S. E. ; Chalela, J. C. ; McGarvey, M. L. ; Wang, D. Z. ; DeCampo, J. ; Wechsler, L. R. ; Binder, J. R. ; Book, D. ; Tanne, D. ; Daley, S. ; Gorman, M. J. ; Mitsias, P. ; Lewandowski, C. A. ; Levine, S. R. ; Frey, J. L. ; Jahnke, H. ; Zweifler, R. ; Koscicki, N. ; Cruz-Flores, S. ; Verro, Piero ; Tiejen, G. ; Lee, J. M. ; Lowenkopf, T. ; Worrall, B. B. ; Johnston, K. C. ; Fayad, P. ; Boiser, J. ; Giancarlo, T. ; Schuster, A. ; Becker, K. J. ; Karanjia, P. N. ; Shuaib, A. ; Kochanski, P. ; Scott, P. ; Wehner, S. ; Dayno, J. M. ; Bell, R. ; Benesch, C. ; Coplin, W. M. ; Chaturvedi, S. ; Dulli, D. ; Kalafut, M. A. ; Kidwell, C. S. ; Saver, J. L. ; Tanne, D. ; Daley, S. ; Salowich-Palm, L. ; Schultz, L. R. ; D'Olhaberriague, L. ; Levine, S. R. / Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice : The multicenter rt-PA acute stroke survey. In: Circulation. 2002 ; Vol. 105, No. 14. pp. 1679-1685.
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abstract = "Background - Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH. Methods and Results - In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6{\%}) developed symptomatic ICH and 86 additional patients (7{\%}) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH. Conclusions - Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.",
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TY - JOUR

T1 - Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice

T2 - The multicenter rt-PA acute stroke survey

AU - Tanne, David

AU - Kasner, Scott E.

AU - Demchuk, Andrew M.

AU - Koren-Morag, Nira

AU - Hanson, Sandra

AU - Grond, Martin

AU - Levine, Steven R.

AU - Hamilton, S. A.

AU - Hanson, S. K.

AU - Grond, M.

AU - Grotta, J. C.

AU - Morgenstern, L.

AU - Krieger, D.

AU - Kasner, S. E.

AU - Villar, C.

AU - Chiu, D.

AU - Wein, T.

AU - Hickenbottom, S.

AU - Felberg, R.

AU - Demchuk, A. M.

AU - Buchan, A. M.

AU - Demchuk, A. M.

AU - Barber, P.

AU - Newcommon, N.

AU - Bates, V. E.

AU - Vereczkey-Porter, K.

AU - Kasner, S. E.

AU - Chalela, J. C.

AU - McGarvey, M. L.

AU - Wang, D. Z.

AU - DeCampo, J.

AU - Wechsler, L. R.

AU - Binder, J. R.

AU - Book, D.

AU - Tanne, D.

AU - Daley, S.

AU - Gorman, M. J.

AU - Mitsias, P.

AU - Lewandowski, C. A.

AU - Levine, S. R.

AU - Frey, J. L.

AU - Jahnke, H.

AU - Zweifler, R.

AU - Koscicki, N.

AU - Cruz-Flores, S.

AU - Verro, Piero

AU - Tiejen, G.

AU - Lee, J. M.

AU - Lowenkopf, T.

AU - Worrall, B. B.

AU - Johnston, K. C.

AU - Fayad, P.

AU - Boiser, J.

AU - Giancarlo, T.

AU - Schuster, A.

AU - Becker, K. J.

AU - Karanjia, P. N.

AU - Shuaib, A.

AU - Kochanski, P.

AU - Scott, P.

AU - Wehner, S.

AU - Dayno, J. M.

AU - Bell, R.

AU - Benesch, C.

AU - Coplin, W. M.

AU - Chaturvedi, S.

AU - Dulli, D.

AU - Kalafut, M. A.

AU - Kidwell, C. S.

AU - Saver, J. L.

AU - Tanne, D.

AU - Daley, S.

AU - Salowich-Palm, L.

AU - Schultz, L. R.

AU - D'Olhaberriague, L.

AU - Levine, S. R.

PY - 2002/4/9

Y1 - 2002/4/9

N2 - Background - Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH. Methods and Results - In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH. Conclusions - Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.

AB - Background - Intravenous recombinant tissue plasminogen activator (rtPA) is an effective therapy for acute ischemic stroke, but it is associated with risk of intracerebral hemorrhage (ICH). Our aim was to identify, in a large cohort of patients, readily available baseline factors that are associated with thrombolysis-related ICH. Methods and Results - In a multicenter retrospective and prospective investigation of individual data from 1205 patients treated in routine clinical practice with intravenous rtPA within 3 hours of stroke symptom onset, 72 patients (6%) developed symptomatic ICH and 86 additional patients (7%) had asymptomatic ICH identified on a routine follow-up CT. In analyses based on clinical variables alone, the main attributes associated with ICH were a history of diabetes mellitus and cardiac disease, increasing stroke severity, advancing age, use of antiplatelet agents other than aspirin before stroke onset, and elevated pretreatment mean blood pressure. In additional analyses that incorporated baseline CT and laboratory findings (in a subset of patients), the main associations were early ischemic CT changes, in particular if exceeding one third of middle cerebral artery territory; increasing stroke severity; diabetes mellitus or elevated serum glucose; and lower platelet counts. Final independent attributes associated with parenchymatous hematoma, defined by purely radiologically based criteria, were similar to those of symptomatic ICH. Conclusions - Readily available factors can identify acute ischemic stroke patients at high and low risk for rtPA-related ICH. These factors require confirmation in a prospective cohort before clinical implementation.

KW - Hemorrhage

KW - Plasminogen activators

KW - Stroke

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