Predictors of post-thrombolysis symptomatic intracranial hemorrhage in Chinese patients with acute ischemic stroke

Background and purpose
Predictors of symptomatic intracranial hemorrhage (sICH) in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator remain unclear.
Methods
Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study were assessed to explore risk factors for symptomatic intracranial hemorrhage after intravenous thrombolysis. Three candidate sICH definitions were analyzed.
Results
Among 1128 patients with acute ischemic stroke treated with intravenous rtPA within 4.5 hours of symptom onset, 23 (2.0%), 44(3.9%) and 61 (5.4%) experienced modified mSITS-MOST, ECASS II, and NINDS defined sICH, respectively. Multivariate logistic regression revealed independent risk factors for sICH were age≧70 years-old(sICH per NINDS, adjusted OR = 1.73[95%CI1.02–2.95],p = 0.04),diabetes(sICH per SITS-MOST, adjusted OR = 3.50 [95%CI1.34–9.16], p = 0.01), serum glucose on admission >9.0mmol/L(sICH per ECASS II, adjusted OR = 2.84[95%CI1.48–5.46], p = 0.002),NIHSS on admission>20(sICH per SITS-MOST, adjusted OR = 5.06[95%CI1.68–15.20], p = 0.004 or sICH per NINDS, adjusted OR 2.81[95%CI1.42–5.57], p = 0.003) and cardioembolism(sICH per SITS-MOST, adjusted OR = 7.09[95%CI2.41–20.87], p<0.001 or sICH per ECASS II, adjusted OR = 4.99[95%CI2.53–9.84], p<0.001)or sICH per NINDS, adjusted OR = 2.47[95%CI1.39–4.39], p = 0.002).
Conclusion
Cardioembolism, NIHSS on admission higher than 20, serum glucose on admission higher than 9.0 mmol/L and age ≧70 years were independent risk factors for symptomatic intracranial hemorrhage in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator.