Abstract W MP11: Does Intravenous t-PA Before Acute Stroke Intervention Increase Intracranial Hemorrhage? -Subanalysis of Rescue-japan Registry
Objective: It has not been clarified whether combination therapy of intravenous t-PA (IV t-PA) and acute stroke intervention (ASI) increase intracranial hemorrhage (ICH). The aim of this study was to investigate the relationship between IV tPA and intracranial hemorrhage at every occluded vessel using data of RESCUE-Japan Registry.
Methods: Among 1,442 acute cerebral infarction patients due to major vessel occlusion within 24 hours who were enrolled in RESCUE-Japan registry, we examined the influence of IV tPA for intracranial bleeding according to a vessel occlusion site in 410 patients who were received ASI. The site of occlusion was classified as Internal carotid artery (ICA), M1 and M2 in Middle cerebral artery, Vertebral artery (VA), and Basilar artery (BA). Intracranial hemorrhage was defined as any intracranial hemorrhage (aICH) and symptomatic ICH (sICH) which worsened more than 4 points in National Institution of Health Stroke Scale (NIHSS).
Result: Among 410 patients, aICH was found in 127 (30.9%) and sICH was found in 20 (4.9%). According to the occluded vessel, ASI after IV tPA did not increased both aICH and sICH in ICA, M1, VA, and BA. In analysis of M2, ASI after IV tPA significantly increased sICH (0% vs 18.75%, p=0.0245). For multivariate analysis, age over 75 years old, more than 20 points in NIHSS tended to increase sICH (p=0.0507, respectively), and IV tPA was independent risk factor for increase of sICH (p=0.0102). On the other hand, IV tPA did not increase aICH in M2 occlusion (p=0.7059). In multivariate analysis in M2 occlusion, more than 20 points in NIHSS (p=0.0057), heparin use in ASI (p<0.0001), pre-antiplatelet therapy (p=0.0004) were independent risk factors.
Conclusion: In acute brain infarction, ASI after IV tPA did not increase ICH totally, but sICH was increased in M2. IV tPA before ASI in small vessel was thought to be a risk factor of increase sICH.
Author Disclosures: T. Takagi: None. S. Yoshimura: None. Y. Enomoto: None. Y. Egashira: None. H. Yamagami: None. N. Sakai: None. Y. Okada: None. K. Kitagawa: None. K. Kimura: None. N. Tanahashi: None. T. Hyogo: None.
- © 2015 by American Heart Association, Inc.