Blood Pressure Management and Evolution of Thrombolysis-associated Intracerebral Hemorrhage in Acute Ischemic Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 21; no. 8; pp. 852 - 859
• Main Authors: Mokin, Maxim, MD, PhD, Kass-Hout, Tareq, MD, Kass-Hout, Omar, MD, Zivadinov, Robert, MD, PhD, Mehta, Bijal, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2012
• Subjects: Acute stroke; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; blood pressure; Blood Pressure - drug effects; Brain Ischemia - drug therapy; Cardiovascular; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - physiopathology; Disease Progression; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Hematoma - chemically induced; Hematoma - diagnostic imaging; Hematoma - physiopathology; Humans; intracerebral hemorrhage; Male; Middle Aged; Neurology; Retrospective Studies; Stroke - drug therapy; Systole; thrombolysis; Thrombolytic Therapy - adverse effects; Time Factors; tissue plasminogen activator; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Tomography, X-Ray Computed; intracerebral hemorrhage; thrombolysis; blood pressure; tissue plasminogen activator; Acute stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2011.05.006

Background There is limited knowledge on the radiographic features of thrombolysis-induced hemorrhage. The factors that influence early hematoma expansion have not been elucidated. Methods Patients presenting with a symptomatic intracerebral hemorrhage (ICH) as a result of intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) for acute ischemic stroke and had noncontrast computed tomographic (CT) scans of the head were included in this retrospective study. Calculation of hematoma volumes was obtained. Analysis of covariance was used to evaluate for the effect of baseline blood pressure (BP) on initial hematoma volume and further growth. Results Of 267 patients who were treated with intravenous tPA for acute ischemic stroke at our facility between January 1, 2005 and December 31, 2009, 17 patients developed symptomatic ICH and were included in the final analysis. There was a positive correlation between baseline level of systolic BP after thrombolysis and initial hematoma volume (r = 0.46; P = .03) but not for the diastolic BP (r = 0.07; P = .40). There was a significant increase in mean hematoma volume expansion when comparing results between the first and second CT scans (median 9 hours, 22 minutes; 14.9 ± 19.6 cm3 to 26.0 ± 26.7 cm3 ; P = .04). There was also a negative association between the reduction of systolic BP and hematoma growth (r = -0.67; P = .02), but no correlation with change in diastolic BP (r = -0.22; P = .28). Conclusions Once diagnosed, thrombolysis-induced symptomatic ICH undergoes significant early expansion in size. Systolic BP may play a role in hematoma expansion.