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CC BY-NC-ND 4.0 · J Neurosci Rural Pract 2020; 11(02): 315-324
DOI: 10.1055/s-0040-1709946
Original Article

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Suman Das
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Gourango Prosad Mondal
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Ramesh Bhattacharya
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Kartick Chandra Ghosh
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Sarbajit Das
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Hema Krishna Pattem
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Shabir Ahmed Paul
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
,
Chandrakanta Patra
1   Department of Neurology, Calcutta National Medical College, Kolkata, India
› Author Affiliations Funding None.
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Abstract

Background Thrombolysis improves the outcome in acute ischemic stroke (AIS), albeit with an increased risk of symptomatic intracranial hemorrhage (sICH). Biomarkers to find patients at risk of sICH, and guide treatment and prognosis would be valuable.

Methods Consecutive patients of AIS thrombolysed between February 2017 and September 2019 at Calcutta National Medical College were studied prospectively for sICH and outcome at 6-month follow-up. We identified the independent risk factors for unfavorable outcomes, mortality, and sICH using multivariate analysis. Prethrombolysis and 24-hour postthrombolysis fibrinogen levels were estimated to evaluate its biomarker role.

Results Out of 180 AIS patients admitted during the study period, 60 patients were thrombolysed. Door to needle time was <3 hours among 24 patients and 3 to 4.5 hours among 36 patients. Favorable outcomes occurred among 76.67% and sICH occurred among 13.33% patients. Upper tertile of National Institute of Health Stroke Scale (NIHSS) had the highest adjusted odds for sICH (17.5 [95% confidence intervals=1.7–178.44]). Total anterior circulation stroke had the highest adjusted odds for unfavorable outcome (19.11 [3.9–92.6]). Following thrombolysis, the mean (standard deviation) fibrinogen level of 449.27 (32.87) decreased 7% to postthrombolysis level of 420 (20.5; p< 0.0001). Higher tertiles of fibrinogen levels had progressively increasing odds for morbidity and sICH.

Conclusion  Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke (double weight), i.e., CHADS2 score >2, low ejection fraction, the occurrence of total anterior circulation stroke and higher mean arterial blood pressure, blood glucose level, NIHSS score, and fibrinogen at admission were the common risk factors significantly predicting postthrombolysis sICH and morbidity. Antiplatelet and anticoagulant therapy, lower ASPECT (Alberta Stroke Program Early CT Score), and higher SEDAN scores also predicted sICH . Fibrinogen levels were significantly higher among those developing sICH and having unfavorable outcome. The performance of thrombolysis within 3 hours or between 3 and 4.5 hours after symptom onset did not affect morbidity, mortality, or the occurrence of sICH.

Keywords

thrombolysis - intracranial hemorrhage - alteplase - modified Rankin scale - fibrinogen


Publication History

Publication Date:
02 May 2020 (online)

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