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(Circulation. 2002;105:e9094.)
© 2002 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH

Circulation Newswriter

Identifying the Stroke Victim at Risk for Hemorrhage During Thrombolysis

Diabetes mellitus, cardiac disease, increasing stroke severity, old age, antiplatelet agents other than aspirin used before stroke, and high blood pressure before treatment increase the risk of brain hemorrhage in stroke patients undergoing thrombolysis with recombinant tissue-type plasminogen activator (rtPA), according to researchers who participated in the Multicenter rt-PA Acute Stroke Survey. The report of that study appears in this week’s issue of Circulation (Circulation. 2002;105:1679–1685).

Identifying patients at highest risk of intracerebral hemorrhage after thrombolysis is particularly important because such bleeding is extremely dangerous. Many in the emergency medicine and cardiology communities have said there is a need to identify the subsets of patients who should and should not undergo thrombolysis for stroke.

In their study, the researchers noted that 60% of patients with symptomatic intracerebral hemorrhage died. Of those with asymptomatic intracerebral hemorrhage, 17% died, and of those with no hemorrhage, 10% died. The rate of severe disability was 32% in the group with symptomatic intracerebral hemorrhage, 29% in the asymptomatic group, and 26% in the group without brain hemorrhage. Excellent outcomes were recorded in 4% of the group with symptomatic brain hemorrhage, 21% of those with asymptomatic hemorrhage, and 34% of those with no hemorrhage.

The group, which included researchers from Israel, Pennsylvania, Canada, Minnesota, Germany, and New York, was led by David Tanne, MD, of the Stroke Unit in the Department of Neurology at Chaim Sheba Medical Center in Tel-Hashomer, Israel. The group identified 1205 patients who received rtPA within 3 hours of stroke . . . [Full Text of this Article]