Hemorrhagic Transformation in Acute Ischemic Stroke

Potential Contributing Factors in the European Cooperative Acute Stroke Study

Larrue, Vincent MD
von Kummer, Rudiger MD
del Zoppo, Gregory MD
Bluhmki, Erich BSc

Received November 14, 1996; final revision received January 9, 1997; accepted February 14, 1997.
From the Department of Neurology, Hopital de Rangueil, University of Toulouse (France) (V.L.); the Department of Neuroradiology, University of Dresden (Germany) (R. von K.); the Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, Calif (G. del Z.); and Karl Thomae GmbH and Boehringer Ingelheim, Biberach, Germany (E.B.).
Correspondence to Dr V. Larrue, Service de Neurologie, Hopital de Rangueil, 31403 Toulouse Cedex 04, France.

Stroke 28(5):p 957-960, May 1997.

Background and Purpose

Recent studies suggest that thrombolytic therapy may be of benefit to patients with acute ischemic stroke. However, the treatment also carries a significant risk of hemorrhagic transformation (HT). The purpose of this study was to select potential contributors to HT.

Methods

We provide an explanatory analysis of the European Cooperative Acute Stroke Study (ECASS) data. ECASS was a multicenter, placebo-controlled, randomized trial of recombinant tissue plasminogen activator in ischemic stroke, within 6 hours of symptom onset, which enrolled 620 patients. HTs were classified into either hemorrhagic infarction or parenchymal hemorrhage according to their CT scan appearance. We used logistic regression analysis to select potential contributing factors to each type of HT.

Results

The severity of initial clinical deficit (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.6 to 4.0) and the presence of early ischemic changes on CT scan (OR, 3.5; 95% CI, 2.3 to 5.3) were associated with increased risk of hemorrhagic infarction. Increasing age (in decades; OR, 1.3; 95% CI, 1.0 to 1.7) and treatment with recombinant tissue plasminogen activator (OR, 3.6; 95% CI, 2.1 to 6.1) were related to the risk of parenchymal hemorrhage.

Conclusions

Since all potential contributing factors are readily discernible upon hospital admission, they should be used to improve selection of patients into future studies. (Stroke. 1997;28:957-960.)