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Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors
P P De Jaegere1, A A Arnold, A H Balk
1Department of Cardiology, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.
Insights
Thrombolytic therapy for acute myocardial infarction can cause intracranial hemorrhage, a serious complication. Key risk factors include prior oral anticoagulant use, low body weight (<70 kg), and age over 65.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) treatment often involves thrombolytic agents.
- Thrombolytic therapy, while effective, carries risks, including intracranial hemorrhage (ICH).
- Understanding risk factors for ICH is crucial for patient safety.
Purpose of the Study:
- To identify clinical predictive factors for intracranial hemorrhage in patients receiving thrombolytic therapy for AMI.
- To assess the incidence and outcomes of ICH in this patient population.
Main Methods:
- Prospective registration of 2,469 AMI patients treated with thrombolytics across 61 hospitals over 18 months.
- A case-control study comparing ICH patients with matched controls to identify risk factors.
- Multivariate logistic regression analysis was used to determine significant predictors.
Main Results:
- An overall incidence rate of 1% for ICH was observed (24 of 2,469 patients).
- The median time to ICH onset was 16 hours after thrombolytic therapy initiation.
- Factors associated with increased ICH risk included pre-admission oral anticoagulant use, body weight <70 kg, and age >65 years.
- Mortality due to cerebral hematoma was high, affecting 66% of ICH patients.
Conclusions:
- Patients on oral anticoagulants, those with lower body weight, and older individuals are at higher risk of ICH during thrombolytic therapy for AMI.
- These findings aid in risk stratification and potentially modifying treatment strategies to improve patient outcomes.
Abstract:
In a period of 18 months, 2,469 patients with acute myocardial infarction treated with a thrombolytic agent were prospectively registered in 61 hospitals. Most patients (73%) were treated with streptokinase. Intracranial hemorrhage was observed in 24 patients, corresponding to an incidence rate of 1% (95% confidence interval 0.6% to 1.3%). The median time interval between the start of thrombolytic therapy and the first clinical signs of intracranial bleeding was 16 h (range 3 to 36). In total, 16 (66%) of the 24 patients died as a result of cerebral hematoma. To determine clinical predictive factors, a case-control study was conducted. For every patient with intracranial hemorrhage, two control patients who received thrombolytic therapy because of acute infarction in the same hospital and in the same period were selected. Detailed clinical characteristics of 22 of the 24 patients as well as of 7 other patients with documented intracerebral bleeding from the European Cooperative Study Group and of 2 patients who sustained intracranial hemorrhage outside the registry period were compared with 62 control patients. The results of multivariate logistic regression analysis indicate that patients taking an oral anticoagulant before admission, patients with a body weight less than 70 kg and those greater than 65 years old are at higher risk for intracranial hemorrhage during thrombolytic therapy.