Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis: Stroke territory as a potential pitfall

Sheng Feng Sung, Chih-Hung Chen, Yu Wei Chen, Mei Chiun Tseng, Hsiu Chu Shen, Huey Juan Lin

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Stroke vascular territories may influence response to thrombolysis, although supporting data are limited. The aim of the study was to test the hypothesis that the current available prediction scores might inaccurately estimate the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis in patients with posterior circulation stroke. Methods We applied the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score to data from four hospital-based stroke registries. Patients were grouped according to anterior or posterior circulation stroke. The main outcome measure was SICH per various definitions. Performance of the risk score was assessed with the c statistic. Results Data of 518 thrombolyzed patients (434 anterior, 84 posterior) were studied. The overall rate of SICH varied from 3.5% to 6.9% depending on the SICH definition. Patients with posterior circulation stroke were less likely to have post-thrombolysis SICH per NINDS (P = 0.042), per ECASS II (P = 0.013), or any ICH (P = 0.001), and their rate of SICH was markedly lower than predicted (1.2% versus 7.1% by the NINDS definition; 0% versus 4.8%, ECASS II; 0% versus 1.6%, SITS-MOST). The SITS SICH risk score shows moderate model discrimination across the SICH definitions, with c statistic ranging from 0.64 to 0.70. Conclusions The risk of SICH after intravenous thrombolysis in patients with posterior circulation stroke was low enough to render the SITS SICH risk score or other similar prediction models unnecessary. Awareness of stroke territory might help clinicians judiciously use the risk assessment models.

Original languageEnglish
Pages (from-to)96-100
Number of pages5
JournalJournal of the Neurological Sciences
Volume335
Issue number1-2
DOIs
Publication statusPublished - 2013 Dec 15

Fingerprint

Cerebral Hemorrhage
Stroke
National Institute of Neurological Disorders and Stroke
Blood Vessels
Registries
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Sung, Sheng Feng ; Chen, Chih-Hung ; Chen, Yu Wei ; Tseng, Mei Chiun ; Shen, Hsiu Chu ; Lin, Huey Juan. / Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis : Stroke territory as a potential pitfall. In: Journal of the Neurological Sciences. 2013 ; Vol. 335, No. 1-2. pp. 96-100.
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title = "Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis: Stroke territory as a potential pitfall",
abstract = "Background Stroke vascular territories may influence response to thrombolysis, although supporting data are limited. The aim of the study was to test the hypothesis that the current available prediction scores might inaccurately estimate the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis in patients with posterior circulation stroke. Methods We applied the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score to data from four hospital-based stroke registries. Patients were grouped according to anterior or posterior circulation stroke. The main outcome measure was SICH per various definitions. Performance of the risk score was assessed with the c statistic. Results Data of 518 thrombolyzed patients (434 anterior, 84 posterior) were studied. The overall rate of SICH varied from 3.5{\%} to 6.9{\%} depending on the SICH definition. Patients with posterior circulation stroke were less likely to have post-thrombolysis SICH per NINDS (P = 0.042), per ECASS II (P = 0.013), or any ICH (P = 0.001), and their rate of SICH was markedly lower than predicted (1.2{\%} versus 7.1{\%} by the NINDS definition; 0{\%} versus 4.8{\%}, ECASS II; 0{\%} versus 1.6{\%}, SITS-MOST). The SITS SICH risk score shows moderate model discrimination across the SICH definitions, with c statistic ranging from 0.64 to 0.70. Conclusions The risk of SICH after intravenous thrombolysis in patients with posterior circulation stroke was low enough to render the SITS SICH risk score or other similar prediction models unnecessary. Awareness of stroke territory might help clinicians judiciously use the risk assessment models.",
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Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis : Stroke territory as a potential pitfall. / Sung, Sheng Feng; Chen, Chih-Hung; Chen, Yu Wei; Tseng, Mei Chiun; Shen, Hsiu Chu; Lin, Huey Juan.

In: Journal of the Neurological Sciences, Vol. 335, No. 1-2, 15.12.2013, p. 96-100.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis

T2 - Stroke territory as a potential pitfall

AU - Sung, Sheng Feng

AU - Chen, Chih-Hung

AU - Chen, Yu Wei

AU - Tseng, Mei Chiun

AU - Shen, Hsiu Chu

AU - Lin, Huey Juan

PY - 2013/12/15

Y1 - 2013/12/15

N2 - Background Stroke vascular territories may influence response to thrombolysis, although supporting data are limited. The aim of the study was to test the hypothesis that the current available prediction scores might inaccurately estimate the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis in patients with posterior circulation stroke. Methods We applied the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score to data from four hospital-based stroke registries. Patients were grouped according to anterior or posterior circulation stroke. The main outcome measure was SICH per various definitions. Performance of the risk score was assessed with the c statistic. Results Data of 518 thrombolyzed patients (434 anterior, 84 posterior) were studied. The overall rate of SICH varied from 3.5% to 6.9% depending on the SICH definition. Patients with posterior circulation stroke were less likely to have post-thrombolysis SICH per NINDS (P = 0.042), per ECASS II (P = 0.013), or any ICH (P = 0.001), and their rate of SICH was markedly lower than predicted (1.2% versus 7.1% by the NINDS definition; 0% versus 4.8%, ECASS II; 0% versus 1.6%, SITS-MOST). The SITS SICH risk score shows moderate model discrimination across the SICH definitions, with c statistic ranging from 0.64 to 0.70. Conclusions The risk of SICH after intravenous thrombolysis in patients with posterior circulation stroke was low enough to render the SITS SICH risk score or other similar prediction models unnecessary. Awareness of stroke territory might help clinicians judiciously use the risk assessment models.

AB - Background Stroke vascular territories may influence response to thrombolysis, although supporting data are limited. The aim of the study was to test the hypothesis that the current available prediction scores might inaccurately estimate the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis in patients with posterior circulation stroke. Methods We applied the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score to data from four hospital-based stroke registries. Patients were grouped according to anterior or posterior circulation stroke. The main outcome measure was SICH per various definitions. Performance of the risk score was assessed with the c statistic. Results Data of 518 thrombolyzed patients (434 anterior, 84 posterior) were studied. The overall rate of SICH varied from 3.5% to 6.9% depending on the SICH definition. Patients with posterior circulation stroke were less likely to have post-thrombolysis SICH per NINDS (P = 0.042), per ECASS II (P = 0.013), or any ICH (P = 0.001), and their rate of SICH was markedly lower than predicted (1.2% versus 7.1% by the NINDS definition; 0% versus 4.8%, ECASS II; 0% versus 1.6%, SITS-MOST). The SITS SICH risk score shows moderate model discrimination across the SICH definitions, with c statistic ranging from 0.64 to 0.70. Conclusions The risk of SICH after intravenous thrombolysis in patients with posterior circulation stroke was low enough to render the SITS SICH risk score or other similar prediction models unnecessary. Awareness of stroke territory might help clinicians judiciously use the risk assessment models.

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