Patterns and Clinical Implications of Hemorrhagic Transformation After Thrombolysis in Acute Ischemic Stroke

作者：Yanan Wang, Toshiki Maeda, Shoujiang You, Chen Chen, Leibo Liu, Zien Zhou, Thompson Robinson, Richard I. Lindley, Candice Delcourt, Grant Mair, Joanna M. Wardlaw, John Chalmers, Hisatomi Arima, Yining Huang, Jong S. Kim, Pablo M. Lavados, Tsong‐Hai Lee, Christopher Levi, Mark Parsons, Sheila Cristina Ouriques Martins, Jeyaraj Pandian, Octávio Marques Pontes‐Neto, Vijay K. Sharma, Thang Huy Nguyen, Ji‐Guang Wang, Simiao Wu, Ming Liu, Craig S. Anderson, Xiaoying Chen, for the ENCHANTED Investigators · 发表于：Neurology · 年份：2024 · DOI：10.1212/wnl.0000000000210020 · 被引用次数：21 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Venous Thromboembolism Diagnosis and Management

BACKGROUND AND OBJECTIVES: Hemorrhagic transformation may be a potentially devastating complication of IV thrombolysis (IVT) in acute ischemic stroke, but what degree of hemorrhage indicates the greatest negative effect is not known. We aimed to define the associations between hemorrhagic transformation patterns, classified according to clinical and imaging categories, and clinical outcomes after IVT. METHODS: We conducted a post hoc analysis from the international Enhanced Control of Hypertension and Thrombolysis Stroke Study. Symptomatic intracerebral hemorrhage (sICH) was defined based on established criteria, such as the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. Asymptomatic intracerebral hemorrhage (aICH) was defined as any intracerebral hemorrhage that did not meet the criteria for sICH. Imaging subtypes of hemorrhagic transformation were assessed using the Heidelberg Bleeding Classification system. The primary outcome was death or major disability, defined by modified Rankin scale (mRS) scores 3-6 at 90 days. Secondary outcomes included death, death or disability (mRS 2-6), and poor health-related quality of life (HRQoL), defined as an overall heath utility score ≤0.7 (mean). RESULTS: Of the 4,370 participants, 779 (17.8%) developed any intracranial hemorrhage (ICH), with a median time from randomization to hemorrhage of 23.5 hours (interquartile range 18.92-26.07). According to the SITS-MOST criteria, 62 patients (1.4% of 4,3...