Factors Associated with Intracerebral Hemorrhage after Treatment with Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke in Phra Nakhon Sri Ayutthaya Hospital

Abstract

Acute ischemic stroke is a common neurological disorder. Nowadays, intravenous recombinant tissue-type plasminogen activator (rt-PA) is a thrombolytic drug that is recommended for treatment of patients with acute ischemic stroke who came to the hospital within 4.5 hours. The major and serious side effect of rt-PA is intracerebral hemorrhage (ICH). Before giving rt-PA, doctors had to check contraindications of this drug. Although patients receiving rt-PA had no contraindication, some of them suffered from ICH after the treatment with rt-PA. Nowadays, there are many researchs to find out which factors related to ICH after receiving rt-PA, but different factors were found in each study. Many researchs were studied in other countries but only a few researchs were studied in Thailand.  

Objective: To determine risk factors associated with ICH after treatment with rt-PA for acute ischemic stroke in patients admitted in Phra Nakhon Sri Ayutthaya Hospital.

Method: This study is a retrospective observational study. We reviewed all patients with acute ischemic stroke who received treatment with rt-PA within 4.5 hours of stroke onset at stroke unit, Phra Nakhon Sri Ayutthaya hospital, Thailand during October 2017 and August 2020. There were 153 patients in this study. Patients were devided into two groups upon occurring ICH and no ICH within 24 hours after treatment with rt-PA. Baseline characteristics, vital signs, and other factors were collected, analyzed, and compared between two groups. Correlative factors were analyzed by using multivariable logistic regression analysis.

Outcomes: There were 153 patients receiving rt-PA. 22 patients (14.4%) developed ICH. This study showed that 4 baseline factors were significantly associated with ICH. First, prior clopidogrel using increased risk of ICH (OR 13.364, p = 0.008). Second, high baseline National Institutes of Health Stroke Scale (NIHSS) was increasing risk of ICH (OR 1.132, p = 0.013). Third, high capillary plasma glucose (CPG) was linked with risk of ICH (OR 1.012, p = 0.011). Finally, history of receiving antihypertensive drug (IV Nicardipine) for decreasing blood pressure below 185/110 mmHg before infusion of rt-PA was significantly associated with ICH (OR 10.805, p = 0.003).

Conclusion: Clopidogrel using, high baseline NIHSS, high CPG and history of receiving intravenous antihypertensive drug before infusion of rt-PA related to ICH after treatment with rt-PA. So If patients have one or more of these factors, doctor should aware and prepare initial treatments before giving rt-PA to the patients.