(Stroke. 2000;31:1802.)
© 2000 American Heart Association, Inc.
Original Contributions |
Intracranial Hemorrhage Associated With Thrombolytic Therapy for Elderly Patients With Acute Myocardial Infarction
Results From the Cooperative Cardiovascular Project
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (L.M.B., J.H.L., M.J.R., H.M.K.); Neurology Service, VA Connecticut Healthcare System, West Haven, Conn (L.M.B.); Yale Stroke Program, Department of Neurology (L.M.B., J.H.L.); Section of Chronic Disease Epidemiology, School of Epidemiology and Public Health (L.M.B., H.M.K.), and Department of Cardiology (H.M.K.), Yale University School of Medicine, New Haven, Conn; Qualidigm (L.M.B., Y.W., M.J.R., H.M.K.), Middletown, Conn; and Meyers Primary Care Institute, Fallon Healthcare System and University of Massachusetts Medical School, Worcester (J.H.G.).
Correspondence to Lawrence M. Brass, MD, Yale Stroke Program, Department of Neurology, LCI-700, Yale University School of Medicine, 15 York St, PO Box 208018, New Haven, CT 06520-8018. E-mail Lawrence.Brass{at}yale.edu
Background and Purpose—Intracranial hemorrhage is a serious complication of thrombolytic therapy for acute myocardial infarction, especially among the elderly, but little information exists on estimating risk. Better estimation of risk in individual patients may allow for withholding or using alternate therapies among those at highest risk.
Methods—To quantify the risk and identify predictors of intracranial hemorrhage associated with thrombolytic therapy, we performed a retrospective cohort study using data from medical charts. The study involved nearly all acute-care hospitals in the United States. All Medicare patients discharged with a principal diagnosis of acute myocardial infarction during a 9-month period in 1994 to 1995 were included. The main outcome measure was intracranial hemorrhage among those treated with thrombolytic therapy.
Results—The rate of intracranial hemorrhage was 1.43%
(455 of 31 732). In a logistic model, age 
75 years, female, black
race, prior stroke, blood pressure 160 mm Hg, tissue
plasminogen activator (versus other
thrombolytic agent), excessive anticoagulation
(international normalized ratio 4 or prothrombin time 24), and
below median weight (
65 kg for women; 80 kg for men) were
independent predictors. A risk stratification scale was developed on
the basis of these factors: with none or 1 of the factors (n=6651), the
rate of intracranial hemorrhage was 0.69%; with 2 factors
(n=10 509), 1.02%; with 3 factors (n=9074), 1.63%; with 4 factors
(n=4298), 2.49%; and with 5 factors (n=1071), 4.11%
(Mantel-Haenszel; P<0.001).
Conclusions—The rate of intracranial hemorrhage in older patients after treatment with thrombolytic therapy exceeds 1%. Readily available factors can identify elderly patients with acute myocardial infarction at high and low risk for intracranial hemorrhage associated with thrombolytic therapy.
Key Words: intracranial hemorrhage • myocardial infarction • risk factors • thrombolytic therapy
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