Non-intracranial Hemorrhage And Prognosis Among Stroke Patients Receiving Intravenous Thrombolysis

Purpose:Whether non-intracranial hemorrhage(NICH)associated with intravenous thrombolysis(IVT)is a predictor of intracranial hemorrhage(ICH)and poor prognosis is ambiguous.We sought to analyze the rate of NICH and relationship between NICH and poor outcome in the ischemic stroke population receiving IVT.Methods:The prospective study received all ischemic stroke patients IVT between December 2015 and November 2016 were included.Our stroke registry follows established guidelines to administer intravenous tPA to acute ischemic stroke patients.All patients were prospectively identified and their data were first recorded using paper case report forms and then entered into the computerized stroke registry database designed by EpiData software package(Version 3.1).The case report forms included age,sex,clinical features,medical history,antiplatelet drugs and oral anticoagulation treatment,physical examination,laboratory tests,electrocardiography,transcranial doppler,magnetic resonance imaging(MRI),carotid imaging,National Institutes of Health Stroke Scale(NIHSS)score and modified Rankin Scale(mRS)score.On the basis of modified Rank Scale(mRS),ninety-day outcome was divided into favorable(mRS,0-1)versus unfavorable outcome(mRS,2-6)and independency(mRS,0-2)versus dependency and death(mRS,3-6).All statistical analyses were performed by the SPSS software package(version 16.0;SSPS Inc).Continuous variables were tested for normality and are given as median and range or mean and SD as appropriate.Categorical variables are presented as frequencies and percentages.In group comparisons,continuous variables were analyzed by t test;categorical variables were analyzed by chi-square tests and Fisher's exact test if counts <5.To identify independent predictors for NICH multivariate binary logistic regression analysis was carried out.Results:A total of 212 patients receiving IVT were included in the analysis.Forty five NICH events were reported in 42(19.8%)patients.Older age was independently associated with NICH(P=0.049,OR=0.97,95%CI [0.94-1.0]).Neither NICH with BARC class?1(P=0.56,OR=0.61,95%CI [0.11-3.24])nor NICH with BARC class ?2(P=0.87,OR=1.19,95%CI [0.14-10.23])was associated with ICH.NICH with BARC class ?1 was not associated with unfavorable outcome(P=0.67,OR=1.17,95%CI [0.56-2.45])and dependence/death(P=0.47,OR=0.72,95%CI [0.30-1.75]),neither was NICH with BARC class?2(P=0.97,OR=1.02,95%CI [0.46-2.27] and P=0.30,OR=0.59,95%CI [0.22-1.62]).Conclusions:NICH was common among ischemic stroke populations receiving IVT.NICH with BARC class ?2 was not associated with ICH and poor outcome.