• Ju-Hun Lee, Kwang-Yeol Park, Joon-Hyun Shin, Jae-Kwan Cha, Hahn-Young Kim, Jee-Hyun Kwon, Hyung Geun Oh, Kyung Bok Lee, Dong-Eog Kim, Sang-Won Ha, Kyung-Hee Cho, Sung-Il Sohn, Mi-Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, and Sun U Kwon.
• Department of Neurology, Kang-Dong Sacred Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea.
• Eur. Neurol. 2010 Jan 1;64(4):193-200.

Background And PurposePatients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF).MethodsOf the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration.ResultsOf the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 10(4) increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055).ConclusionsCaution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.Copyright © 2010 S. Karger AG, Basel.

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