• Nandakumar Nagaraja, Nudrat Tasneem, Amir Shaban, Sudeepta Dandapat, Uzair Ahmed, Bruno Policeni, Heena Olalde, Hyungsub Shim, Edgar A Samaniego, Connie Pieper, Santiago Ortega-Gutierrez, Enrique C Leira, and Harold P Adams.
• Department of Neurology, University of Florida College of Medicine, Gainesville, Florida; Department of Neurology, Carver College of Medicine, University of Iowa, Iowa. Electronic address: Nandakumar.nagaraja@neurology.ufl.edu.
• J Stroke Cerebrovasc Dis. 2018 May 1; 27 (5): 1403-1411.

Background And PurposeIntravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation.MethodsConsecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation. The clinical data, lipid levels, platelet count, MRI, and computed tomography images were retrospectively reviewed.ResultsThe study included 366 patients, with mean age 67 ± 15 years; 46% were women and 88% were white. The median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range 3-15). Hemorrhagic transformation was observed in 87 (23.8%) patients and cerebral microbleeds were noted in 95 (25.9%). Patients with hemorrhagic transformation tended to be older, nonwhite, have atrial fibrillation, higher baseline NIHSS score, lower cholesterol and triglyceride levels, and cerebral microbleeds and nonlacunar infarcts. Patients with cerebral microbleeds were more likely to be older, have hypertension, hyperlipidemia, previous history of stroke, and prior use of antithrombotics. On multivariate analysis race, NIHSS score, nonlacunar infarct, and presence of cerebral microbleeds were independently associated with hemorrhagic transformation following treatment with rt-PA.ConclusionsPresence of cerebral microbleeds is an independent predictor of hemorrhagic transformation of acute ischemic stroke following treatment with rt-PA.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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