Abstract T MP95: Treatment and Outcome of Thrombolysis Related Hemorrhage: A Multi-center Retrospective Study
Background: The most feared complication from thrombolysis is symptomatic intracerebral hemorrhage (sICH). Current treatments for sICH are based on limited data. We aim to the efficacy of treatments utilized.
Methods: We conducted a collaborative study from 5 academic stroke centers (Columbia University, Massachusetts General Hospital, University of Arkansas, Washington University, and UCLA) on acute post-thrombolysis sICH treatment. The definition of sICH was based on the Safe Implementation of Thrombolysis in Stroke criteria. The primary outcome was in-hospital mortality. Analysis was performed using Fisher’s test and independent t-test, followed by multivariable regression; p<0.05 was statistically significant.
Results: We identified 87 patients with sICH from 1/09 to 4/14. Mean time from rtPA infusion to sICH diagnosis was 12±10 hours and mean time to treatment after diagnosis 2.5 ± 2.3 hours. 91% were diagnosed more than 2 hours from initiation of rtPA. The median NIHSS was lower in patients diagnosed in the first 3 hours versus after 3 hours (10 vs. 18, p=0.01). We found no association between receiving any treatment versus none with in-hospital mortality (37% vs 52%, p = 0.1). Factors associated with higher mortality were code status change within 24 hours (56% vs. 13%, p<0.001), endovascular treatment (27% vs. 9%, p=0.04), and pre-thrombolysis warfarin (10% vs. 0%, p = 0.04). There was trend towards lower mortality with neurosurgical treatment (13% vs. 2%, p = 0.1), and hematoma volume less than 30 cc (30% vs. 53%, p = 0.1). In multivariable models, code status change (OR = 6.2, CI 2.0-20), hematoma volume more than 30 ml (OR = 4.9, CI 1.2-19.6), and endovascular treatment (OR = 4.8, CI 1.1-20.2) were associated with increased in-hospital mortality.
Conclusion: The treatment of post-thrombolysis sICH did not reduce mortality. Possible explanations include perception of futility, prolonged time to diagnosis, and endovascular treatment. More aggressive neurological monitoring beyond two hours from rtPA and screening high risk patients, especially those with high NIHSS score may potentially reduce time to diagnosis/treatment. Innovative treatment with high efficacy and short onset of action should be studied to improve the outcome of sICH.
Author Disclosures: S. Yaghi: None. C.R. Leon-Guerrero: None. J. Dibu: None. S. Ali: None. A. Noorian: None. S.G. Keyrouz: None. L. Schwamm: Research Grant; Significant; PI of MR Wittness, supported by NINDS and Genetech. A. Hinduja: None. N. Bianchi: None. D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. R.S. Marshall: None. J.Z. Willey: None.
- © 2015 by American Heart Association, Inc.