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BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH. METHODS: We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score. RESULTS: We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70. CONCLUSIONS: The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.

Original publication

DOI

10.1161/STROKEAHA.111.644815

Type

Journal article

Journal

Stroke

Publication Date

06/2012

Volume

43

Pages

1524 - 1531

Keywords

Age Factors, Aged, Aspirin, Body Weight, Brain Ischemia, Cerebral Hemorrhage, Clopidogrel, Female, Fibrinolytic Agents, Humans, Hypertension, Injections, Intravenous, Logistic Models, Male, Middle Aged, Platelet Aggregation Inhibitors, Predictive Value of Tests, Registries, Risk Factors, Stroke, Ticlopidine, Tissue Plasminogen Activator