Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion. (5th December 2014)

• Record Type: Journal Article
• Authors: Sairanen, T.; Strbian, D.; Ruuskanen, R.; Silvennoinen, H.; Salonen, O.; Lindsberg, P. J.
• Is Part Of: European journal of neurology. Volume 22:Number 3(2015:Mar.)
• Page Start: 493
• Page End: 499
• Publication Date: 2014-12-05
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12597
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" id="ene12597-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12597-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>Our aim was to determine factors associated with symptomatic intracranial haemorrhage (sICH) in basilar artery occlusion patients treated with intravenous thrombolysis (IVT) and adjuvant anticoagulant therapy.</p> </sec> <sec id="ene12597-sec-0002" sec-type="section"> <title>Methods</title> <p>A registry of 176 consecutive patients with angiography‐proven basilar artery occlusion who received IVT with alteplase and heparin between 1995 to 2013 was assessed. Post‐treatment sICH was evaluated with the European Cooperative Acute Stroke Study II criteria. Unfavourable outcome was defined as a modified Rankin Scale score of 3–6 at 3 months.</p> </sec> <sec id="ene12597-sec-0003" sec-type="section"> <title>Results</title> <p>Twenty‐four patients developed sICH (13.6%, sICH+), all of whom had unfavourable outcome and only two (8.3%) sICH+ patients survived. On admission, sICH+ patients more frequently had extensive ischaemic changes defined as posterior circulation Acute Stroke Prognosis Early CT Score (PC‐ASPECTS) < 8 (50% vs. 27% in sICH−, <italic>P</italic> = 0.031) and lower platelet counts (183 vs. 218 E9/l; <italic>P</italic> = 0.011). They also had higher systolic blood pressure (SBP) (median 160 vs. 147 mmHg, <italic>P</italic> = 0.034) immediately after IVT. In multivariable regression analysis, lower platelet values [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.97–0.996; <italic>P</italic> = 0.006], PC‐ASPECTS < 8 on admission (OR 3.6, 95% CI 1.3–10.3; <italic>P</italic> = 0.017) and higher SBP after treatment (OR 1.03, 95% CI 1.01–1.05; <italic>P</italic> = 0.017) were independently associated with sICH. Ninety per cent of the sICHs occurred within 48 h from IVT/anticoagulation treatment. No differences in activated partial thrompoplastin times prior to or after the treatment were observed between sICH+ and sICH− patients.</p> </sec> <sec id="ene12597-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The risk of sICH was largely determined by extension of ischaemic changes on admission computed tomography. Clinically relevantly, also higher post‐thrombolytic SBP as described earlier and lower perithrombolytic platelet counts do increase the risk, a finding requiring confirmation in other patient series.</p> </sec> </abstract>