• Mahmoud AbdelMageed AbdelRazek, Ashkan Mowla, David Hojnacki, Wendy Zimmer, Rabab Elsadek, Nour Abdelhamid, Lobna Elsadek, Salman Farooq, Haris Kamal, Annemarie Crumlish, Peyman Shirani, Marilou Ching, and Robert Sawyer.
• Department of Neurology, State University of NY at Buffalo, Buffalo, N.Y., USA.
• Cerebrovasc. Dis. 2015 Jan 1; 40 (5-6): 201-4.

BackgroundThe NINDS trial demonstrated the efficacy of intravenous (IV) recombinant tissue plasminogen activator (rtPA) in improving the neurologic outcome in patients presenting with acute ischemic strokes. Patients who had a prior history of intracranial hemorrhage (ICH) were excluded from this trial, possibly due to a hypothetical increase in the subsequent bleeding risk. Thus, there is little data available, whether against or in favor of, the use of IV rtPA in patients with prior ICH. We aim to aid in determining the safety of IV rtPA in such patients through a retrospective hospital-based single center study.MethodsWe reviewed the brain imaging of all patients who received IV rtPA at our comprehensive stroke center from January 2006 to April 2014 for evidence of prior ICH at the time of IV rtPA administration. Their outcomes were determined in terms of subsequent development of symptomatic ICH as defined by the NINDS trial.ResultsBrain imaging for 640 patients was reviewed. A total of 27 patients showed evidence of prior ICH at the time of IV thrombolysis, all intra-parenchymal. Only 1 patient (3.7%) developed subsequent symptomatic ICH after the administration of IV rtPA. Of the remaining 613 patients who received IV rtPA, 25 patients (4.1%) developed symptomatic ICH.ConclusionThis retrospective study provides Level C evidence that patients with imaging evidence of prior asymptomatic intra-parenchymal hemorrhage presenting with an acute ischemic stroke do not show an increased risk of developing symptomatic ICH after IV thrombolysis.© 2015 S. Karger AG, Basel.

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