Abstract T MP15: Post IV Thrombolytic Headache Does Not Predict Hemorrhagic Transformation Risk in Acute Ischemic Stroke
Background: Headache, during or soon after IV infusion of tPA in patients with acute ischemic stroke (AIS) is a concern for hemorrhagic transformation (HT) per various AIS treatment protocols. However no data is available regarding the rate of HT in these patients or the prognostic significance of such headaches.
Objective: To examine the significance of tPA associated headaches in terms of HT rates and clinical outcomes among AIS patients.
Methods: AIS patients treated with IV tPA at a comprehensive stroke center between Jan, 2007 and Nov, 2012 were retrospectively reviewed for documented tPA associated headache; defined as new headache or worsening of pre-treatment headache in the first 24 hours post tPA. Out of 250 charts, headache status was documented in 193. For these, basic demographics including age, gender, and co-morbidities were collected. We compared and analyzed the two groups (headache vs. no headache) for differences in various clinical and radiological outcomes.
Results: Of 193 patients, 63 (32.6%) had tPA associated headache. Headache patients (HP) were significantly younger (mean± SD, 59.5±17.4 vs. 69.9±15.5, p <.0001) and were 53% men compared to 49.2% of non-headache patients (NHP), p=0.537. Co-morbid conditions (hypertension, diabetic mellitus, coronary artery disease, previous TIA or stroke) did not significantly differ between the two groups, p>0.05. There were no statistically significant differences between HP and NHP in admission NIHSS (11.2±5.7 vs. 11.5±5.5, p=0.6458), NIHSS at 24 hours (6.5±5.7 vs. 7.4±6.9, p=0.4661), NIHSS at discharge (6.7±10.1 vs. 8.1±11.6, p=0.4482), HT [8 (12.7%) vs. 24 (18.4%), p=0.3], cervical artery dissection [3 (4.7%) vs. 5 (3.8%), p=0.764], length of hospitalization (6.29±5 days vs. 6.35±4.7 days, p=0.935), and disposition (Home: 53% vs. 43.1%; acute and sub-acute rehabilitation: 39.6% vs. 40%; nursing facility, hospice, and death: 6.4% vs. 16.9%, p=0.1001).
Conclusion: tPA associated headache does not predict increased risk of HT and has no other prognostic significance in patient with AIS. Prospective studies with larger cohort may be needed to further explore this relationship.
Author Disclosures: A. Razak: None. S. Young Kwon: None. S. Chaudhry: None. H. Kneale: None. A. Al Jajeh: None. S. Hussain: None.
- © 2014 by American Heart Association, Inc.