Abstract T P306: The Association Between Treatments and Hematoma Expansion in Thrombolysis Related Hemorrhage: A Multicenter Retrospective Study
Background: Symptomatic intracerebral hemorrhage (sICH) is the most feared complication of thrombolytic therapy in acute ischemic stroke. There is limited data on efficacy of treatments to prevent hematoma expansion (HE). We hypothesized that treatment for sICH would reduce HE.
Methods: This study was a collaboration from 5 stroke centers (Columbia University, Massachusetts General Hospital, University of Arkansas, Washington University, and UCLA). Outcome was HE, defined as 33% increase in hematoma volume in the first 24 hours.
Results: We identified 87 patients with sICH between 1/2009-4/2014 and analyzed the 70 patients (80%) with follow up scans after sICH; those without a follow-up scan were all made comfort care in the first 24 hours and expired. HE occurred in 18 patients (26%); mean duration to diagnosis of sICH was 13±10 hours and mean duration to treatment after detection was 2.4±1.8 hours. On univariate analysis, the only factor associated with increased risk of HE was platelet transfusion (50% vs. 15%,p<0.008). Providing any treatment for sICH vs. none was not associated with reduced HE. There was a trend towards HE with cryoprecipitate treatment (44% vs 23%,p=0.1), time to sICH < 12 hours (42% vs. 19%,p=0.1), and post-thrombolysis fibrinogen < 150 mg/dL (75% vs. 31%,p=0.1). After adjusting for code status, the odds of a patient being treated was increased if the time to diagnosis was <12 hours (OR 5.73, 95%CI 1.46-22.6). After adjusting for time to sICH diagnosis, there was no longer an association between HE and cryoprecipitate use (OR 0.94, 95%CI 0.20-4.46), however, there remained a non-significant association between platelet transfusion and HE(OR 2.93, 95%CI 0.56-15.3). In multi-variable models, none of the treatments given or pretreatment characteristics were associated with reduced HE.
Conclusion: Although our study is underpowered to detect treatment effect, the treatments used to reverse coagulopathy in sICH were not associated with reduced rate of HE across multiple centers. Larger studies are needed to establish an algorithm to diagnose and treat sICH early enough to prevent HE.
Author Disclosures: S. Yaghi: None. C.R. Leon-Guerrero: None. J. Dibu: None. S. Ali: None. A. Noorian: None. A.K. Boehme: None. S.G. Keyrouz: None. A. Hinduja: None. N.A. Bianchi: None. R.S. Marshall: None. D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. L. Schwamm: Research Grant; Significant; PI of MR Wittness, supported by NINDS and Genetech. J.Z. Willey: None.
- © 2015 by American Heart Association, Inc.