Intervention rare for thrombolysis-associated ICH
MedWire News: About 40% of patients with thrombolysis-associated intracerebral hemorrhage (ICH) have ongoing bleeding at the time of diagnosis, shows US research.
This represents a "powerful opportunity" for intervention, say Joshua Goldstein (Massachusetts General Hospital, Boston) and colleagues who call for a multicenter registry to collate data on thrombolysis-associated ICH.
The team analyzed data on 2362 patients included in the Get With the Guidelines-Stroke project. Symptomatic ICH occurred in 19 (6.1%) of 311 patients who received intravenous thrombolysis and two (2.8%) of 72 who received intra-arterial thrombolysis.
Eleven patients with ICH received procoagulant therapies comprising fresh frozen plasma in seven patients, cryoprecipitate in five, vitamin K1 in four, platelets in three, and aminocaproic acid in one patient. Five patients received multiple therapies.
"This heterogeneity likely reflects the absence of evidence supporting any specific intervention," Goldstein et al comment in the Archives of Neurology.
"The low frequency of symptomatic ICH probably contributes to this dearth of data."
Patients were 32.6 times more likely to die in hospital if they suffered symptomatic ICH. Severe stroke, older age, and receipt of intra-arterial thrombolysis were also associated with an increased risk for in-hospital mortality.
Treatment for coagulopathy did not affect patients' outcomes, although this was only relevant to a very small proportion of the whole cohort.
Ten patients underwent follow-up scans, four of whom had evidence of continued bleeding since the diagnostic scan (ICH volume increased by more than a third).
The researchers say that it is not yet clear whether any currently available therapies will benefit patients.
"Nevertheless, our finding that ongoing bleeding is common suggests that a therapeutic opportunity exists," they stress.
"Given the low frequency of symptomatic ICH after thrombolysis, large multicenter prospective trials will be required to determine which therapy can best arrest or prevent ongoing bleeding."
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By Eleanor McDermid