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. 2013 Jun;20(6):962-7.
doi: 10.1111/ene.12126. Epub 2013 Mar 21.

Hemorrhagic transformation in patients with acute ischaemic stroke and an indication for anticoagulation

E B Marsh  1 , R H Llinas, A E Hillis, R F Gottesman
Affiliations

Hemorrhagic transformation in patients with acute ischaemic stroke and an indication for anticoagulation

E B Marsh et al. Eur J Neurol. 2013 Jun.

Abstract

Background and purpose: Intracerebral hemorrhage (ICH) can occur in patients following acute ischaemic stroke in the form of hemorrhagic transformation, and results in significant long-term morbidity and mortality. Anticoagulation theoretically increases risk. We evaluated stroke patients with an indication for anticoagulation to determine the factors associated with hemorrhagic transformation.

Methods: Three-hundred and forty-five patients with ICD-9 codes indicating: (i) acute ischaemic stroke; and (ii) an indication for anticoagulation were screened. One-hundred and twenty-three met inclusion criteria. Data were collected retrospectively. Neuroimaging was reviewed for infarct volume and evidence of ICH. Hemorrhages were classified as: hemorrhagic conversion (petechiae) versus intracerebral hematoma (a space occupying lesion); symptomatic versus asymptomatic. Using multivariable logistic regression, we determined the hypothesized factors associated with intracerebral bleeding.

Results: Age [odds ratio (OR) = 1.50 per 10-year increment, 95% confidence interval (CI) 1.07-2.08], infarct volume (OR = 1.10 per 10 ccs, 95% CI 1.06-1.18) and worsening category of renal impairment by estimated glomerular filtration rate (eGFR; OR = 1.95, 95% CI 1.04-3.66) were predictors of hemorrhagic transformation. Ninety- nine out of 123 patients were anticoagulated. Hemorrhage rates of patients on and off anticoagulation did not differ (25.3% vs. 20.8%; P = 0.79); however, all intracerebral hematomas (n = 7) and symptomatic bleeds (n = 8) occurred in the anticoagulated group.

Conclusions: The risk of hemorrhagic transformation in patients with acute ischaemic stroke and an indication for anticoagulation is multifactorial, and most closely associated with an individual's age, infarct volume and eGFR.

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Conflict of interest statement

Conflicts of Interest:

None.

Figures

Figure 1
Figure 1
Hemorrhagic conversion: petechiae within the area of infarction. Intracerebral hematoma: a space occupying lesion.
See this image and copyright information in PMC

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References

    1. Coull BM, Williams LS, Goldstein LB, Meschia JF, Heitzman D, Chaturvedi S, Johnston KC, Starkman S, Morgenstern LB, Wilterdink JL, Levine SR, Saver JL. Joint Stroke Guideline Development Committee of the American Academy of Neurology, American Stroke Association: Anticoagulants and antiplatelet agents in acute ischemic stroke: report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a division of the American Heart Association) Stroke. 2002;33:1934–1942. - PubMed
    1. Khatri P, Wechsler LR, Broderick JP. Intracranial hemorrhage associated with revascularization therapies. Stroke. 2007;38:431–440. - PubMed
    1. Toni D, Fiorelli M, Bastianello S, Sacchetti ML, Sette G, Argentino C, Montinaro E, Bozzao L. Hemorrhagic transformation of brain infarct: predictability in the first 5 hours from stroke onset and influence on clinical outcome. Neurology. 1996;46:341–345. - PubMed
    1. Hornig CR, Dorndorf W, Agnoli AL. Hemorrhagic cerebral infarction--a prospective study. Stroke. 1986;17:179–185. - PubMed
    1. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators: Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. JAMA. 1998;279:1265–1272. - PubMed

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