Abstract 62: GRASPS Score to Predict Risk of Clinically Relevant Symptomatic Intracranial Hemorrhage after Intravenous Tissue Plasminogen Activator
Background: The NINDS Study definition of symptomatic hemorrhage (sICH) after intravenous tissue plasminogen activator (tPA), requiring only minimal early worsening and minimal petechial hemorrhage, is now widely recognized as overly inclusive. Clinically relevant sICH is better defined by at least moderate worsening and parenchymal hematoma. The 6-item GRASPS scale for predicting sICH was derived from the national US Get with the Guidelines - Stroke registry based on the NINDS Study definition. For use in clinical practice, it is desirable to recalibrate the GRASPS scale to predict more stringently defined symptomatic hemorrhage.
Methods: We merged prospectively collected data of patients with consecutive ischemic stroke who received tPA in 7 stroke centers. We applied the GRASPS (glucose at presentation, race [Asian], age, sex [male], systolic blood pressure at presentation, and severity of stroke at presentation [NIH Stroke Scale]) to predict Safe Implementation of Thrombolysis in Stroke (SITS)-defined sICH. To derive a monotonic predictive model, we used a generalized additive model framework and fit 6 different transformations of the GRASPS score: linear scale, log scale, without and with splines, and without and with local smoothing (“loess”) to identify any non-parametric patterns.
Results: The final cohort comprised 5274 eligible patients, of whom 143 (2.7%) had symptomatic ICH per SITS criteria. Based on favorable residual deviance scores and Akaike's information criterion scores, the linear transformation of raw GRASPS scores provided the best fit. With this model, the area under the curve for predicting SITS sICH was 0.68 (95% CI 0.63-0.72). Risk score values for cardinal GRASPS scale points included 0.6% for GRASPS 50, 2.4% for GRASPS 70, and 9.5% for GRASPS 90.
Conclusions: The GRASPS scale showed moderate performance in predicting SITS-defined symptomatic intracerebral hemorrhage after IV tPA. With the predictive values available from this study, the GRASPS score can be used to assess risk of clinically relevant symptomatic hemorrhage following thrombolytic therapy.
Author Disclosures: J.L. Saver: Other; Modest; Dr. Saver is an employee of the University of California.. D. Strbian: None. P. Michel: Research Grant; Significant; Cardiomet CHUV. Honoraria; Modest; Boehringer-Ingelheim. Consultant/Advisory Board; Modest; Boehringer-Ingelheim. D.J. Seiffge: None. H. Numminen: None. A. Meretoja: None. K. Murao: None. B. Weder: None. N. Forss: None. A. Parkkila: None. A. Eskandari: None. C. Cordonnier: None. S.M. Davis: Honoraria; Modest; Lectures sponsored by Boehringer Ingelheim, Covidien, Pfizer, Siemens. Consultant/Advisory Board; Modest; Boehringer Ingelheim. S.T. Engelter: None. P.G. Jones: None. J.A. Spertus: Research Grant; Modest; Genentech. T. Tatlisumak: Honoraria; Modest; Boehringer-Ingelheim. Consultant/Advisory Board; Modest; Boehringer-Ingelheim, H Lundbeck A/S.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2015 by American Heart Association, Inc.