Clinical Characteristics and Outcome of Patients With Hemorrhagic Transformation After Intravenous Thrombolysis in the WAKE-UP Trial

Frontiers in Neurology

卷:11

Keith W. Muir¹  Jens Fiehler²  Vincent Thijs⁴  Robin Lemmens⁷  Norbert Nighoghossian⁸  Salvador Pedraza⁹  Claus Z. Simonsen¹⁰  Christian Gerloff¹¹  Florent Boutitie¹²  Ivana Galinovic¹³  Jochen B. Fiebach¹³  Matthias Endres¹⁴  Götz Thomalla¹⁸  Bastian Cheng¹⁸  Iris Lettow¹⁸  Eckhard Schlemm¹⁸  Märit Jensen¹⁸  Fanny Quandt¹⁸  Martin Ebinger¹⁹ 

[1] Disease Research, Leuven, Belgium;

[2] 0Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

[3] 1Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia;

[4] 2Austin Health, Department of Neurology, Heidelberg, VIC, Australia;

[5] 3Department of Neurology, University Hospitals Leuven, Leuven, Belgium;

[6] 4Department of Neurosciences, Experimental Neurology, KU Leuven—University of Leuven, Leuven, Belgium;

[7] 5VIB, Laboratory of Neurobiology, Center for Brain &

[8] 6Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom;

[9] 7Department of Stroke Medicine, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France;

[10] 8Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain;

[11] 9Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;

[12] CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France;

[13] Centrum für Schlaganfallforschung Berlin (CSB), Charité—Universitätsmedizin Berlin, Berlin, Germany;

[14] German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany;

[15] German Center for Neurodegenerative Disease (DZNE), Partner Site Berlin, Berlin, Germany;

[16] Hospices Civils de Lyon, Service de Biostatistique, Lyon, France;

[17] Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany;

[18] Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

[19] Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany;

[20] Université Lyon 1, Villeurbanne, France;

关键词: ischemic stroke;    WAKE-UP;    thrombolysis;    intracerebral hemorrhage;    hemorrhagic transformation;   

DOI  :  10.3389/fneur.2020.00957

来源: DOAJ

【 摘 要 】

Background: Hemorrhagic transformation (HT) is an important complication of intravenous thrombolysis with alteplase. HT can show a wide range from petechiae to parenchymal hematoma with mass effect with varying clinical impact. We studied clinical and imaging characteristics of patients with HT and evaluated whether different types of HT are associated with functional outcome.Methods: We performed a post-hoc analysis of WAKE-UP, a multicenter, randomized, placebo-controlled trial of MRI-guided intravenous alteplase in unknown onset stroke. HT was assessed on follow-up MRI or CT and diagnosed as hemorrhagic infarction type 1 and type 2 (HI1 and HI2, combined as HI), and parenchymal hemorrhage type 1 and type 2 (PH1 and PH2, combined as PH). Severity of stroke symptoms was assessed using the National Institutes of Health Stroke Scale (NIHSS) at baseline. Stroke lesion volume was measured on baseline diffusion weighted imaging (DWI). Primary endpoint was a favorable outcome defined as a modified Rankin Scale score 0–1 at 90 days.Results: Of 483 patients included in the analysis, 95 (19.7%) showed HI and 21 (4.4%) had PH. Multiple logistic regression analysis identified treatment with alteplase (OR, 2.08 [95% CI, 1.28–3.40]), baseline NIHSS score (OR, 1.11 [95% CI, 1.05–1.17]), DWI lesion volume (OR, 1.03 [95% CI, 1.01–1.05]), baseline glucose levels (OR, 1.01 [95% CI, 1.00–1.01]) and atrial fibrillation (OR, 3.02 [95% CI, 1.57–5.80]) as predictors of any HT. The same parameters predicted HI. Predictors of PH were baseline NIHSS score (OR, 1.11 [95% CI, 1.01–1.22]) and as a trend treatment with alteplase (OR, 2.40 [95% CI, 0.93–6.96]). PH was associated with lower odds of favorable outcome (OR 0.25, 95% [CI 0.05–0.86]), while HI was not.Conclusion: Our results indicate that HI is associated with stroke severity, cardiovascular risk factors and thrombolysis. PH is a rare complication, more frequent in severe stroke and with thrombolysis. In contrast to HI, PH is associated with worse functional outcome. The impact of HT after MRI-guided intravenous alteplase for unknown onset stroke on clinical outcome is similar as in the trials of stroke thrombolysis within a known early time-window.

【 授权许可】

Unknown