Risk Factors Analysis Of Intracerebral Hemorrhage Transformation After Intravenous Thrombolysis In Acute Cerebral Infarction

Objective: To analyze the related risk factors of cerebral hemorrhage transformation in patients with acute cerebral infarction after intravenous alteplase thrombolysis therapy within time window.Method: One hundred and eighty-six patients with acute cerebral infarction who accepted intravenous alteplase thrombolysis therapy in Fujian Provincial Hospital,Longyan First Hospital and Wuyishan Municipal Hospital from March 2013 to December 2018 were selected as research objects.Fifty-two patients were from Fujian Provincial Hospital,108 patients were from Longyan First Hospital and 26 patients were from Wuyishan Municipal Hospital.The patients were divided into cerebral hemorrhage transformation group and non cerebral hemorrhage transformation group according to their head CT or MRI examinations which were scanned in 24~36 hours after thrombolysis therapy.We collected the data of age,gender,pre-thrombolysis systolic and diastolic pressure,pre-thrombolysis NIHSS score,onset-to-needle time,pre-thrombolysis blood sugar,prothrombin time,activated partial thromboplatin time,fibrinogen,platelet,hemoglobin,homocysteine,serum triglyceride,cholesterol,low density lipoprotein levels,hypertension,diabetes mellitus,history of smoking,past history of stroke and cardioembolism of the patients and analyzed these data by methods of univariate and multivariate logistic regression.Result: Twenty-two patients suffered from cerebral hemorrhage transformation and the incidence was 11.8% among all of the 186 patients.In the cerebral hemorrhage transformation group,9 patients were described as symptomatic intracranial hemorrhage,5 were hemorrhagic infarction 1,8 were hemorrhagic infarction 2,3 were parenchymal hematoma 1 and 6 were parenchymal hematoma 2.Univariate analysis showed that there was no significant difference between the incidence of cerebral hemorrhage transformation in acute cerebral infarction patients after intravenous thrombolysis and age,gender,pre-thrombolysis systolic and diastolic pressure,pre-thrombolysis blood sugar,prothrombin time,activated partial thromboplatin time,fibrinogen,platelet,hemoglobin,homocysteine,serum triglyceride,cholesterol,low density lipoprotein levels,hypertension,diabetes mellitus,history of smoking and past history of stroke(p>0.05).Compared to the non cerebral hemorrhage transformation group,the other group patients had higher pre-thrombolysis NIHSS score(11.59 ±5.779 vs 8.80±6.267,p=0.049),longer onset-to-needle time(212.95±44.704 vs 178.98± 52.407 min,p=0.004)and higher ratio of cardioembolism(14[63.6%] vs 37[22.6%],p=0.000).Their difference had statistical significance(p<0.05).Multivariate logistic regression analysis showed that onset-to-needle time(OR=1.015,p=0.006)and cardioembolism(OR=6.291,p=0.000)were the independent risk factors of the incidence of cerebral hemorrhage transformation in acute cerebral infarction patients after intravenous thrombolysis.Conclusion: Long onset-to-needle time and cardioembolism were the independent risk factors of the incidence of cerebral hemorrhage transformation in patients with acute cerebral infarction accepted intravenous alteplase thrombolysis.