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Multicenter Study
. 2024 Nov 30;14(1):29822.
doi: 10.1038/s41598-024-76189-0.

A multicenter trial on the predictors of different subtypes of hemorrhagic infarction after thrombolysis

Mohamed G Zeinhom  1 , Sherihan Rezk Ahmed  2 , Ahmed Mohamed Kohail  3 , Islam Fathallah Mohamed Kamel  4 , ALshimaa Mahfouz Abdelrahman  5 , Omar M Al-Nozha  6 , Mohamed Almoataz  7 , Tarek Youssif Omar Youssif  8 , Ahmed Mohamed Ali Daabis  9 , Hossam Mohamed Refat  10 , Ahmed Ahmed Mohamed Kamal Ebied  10 , Ahmed Elbassiouny  11 , Ahmed Zaki Omar Akl  11 , Ashfaq Shuaib  12 , Mohamed Ismaiel  13 , Asmaa Ibrahem Desouky Mostafa Ibrahem  14 , Mohamed Fouad Elsayed Khalil  15
Affiliations
Multicenter Study

A multicenter trial on the predictors of different subtypes of hemorrhagic infarction after thrombolysis

Mohamed G Zeinhom et al. Sci Rep. .

Abstract

Worldwide, stroke is a leading cause of long-term disability in adults. Alteplase is the only approved treatment for acute ischemic stroke (AIS) and results in an improvement in a third of treated patients. Most studies evaluated the post-alteplase haemorrhagic transformation of brain infarction as a homogeneous entity but we evaluated the predictors of each subtype of haemorrhagic transformation of brain infarction. Our trial included 616 AIS alteplase-treated patients. We evaluated the ability of different risk factors, clinical presentation, and imaging features to predict different haemorrhagic transformation (HT) subtypes. HT was seen in 152 patients (24.7%), higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction, in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 (odds ratio [OR], 11.04; 95% CI, 9.81 to 12.70; P-value > 0.001) and type2 (OR, 11.89; 95% CI, 9.79 to 14.44; P-value > 0.001), while older age was also an independent predictor of parenchymal hematoma type1 (OR, 1.312; 95% CI, 1.245 to 1.912; P-value 0.02). In AIS patients treated with alteplase in Egypt and Saudi Arabia, higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction; in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 and 2, while older age was also an independent predictor of parenchymal hematoma type1. Trial registration: (clinicaltrials.gov NCT06337175), retrospectively registered on 29/03/2024.

Keywords: Alteplase; Egypt; Hemorrhagic infarction; Middle east; Saudi Arabia.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical review board: This study protocol was reviewed and approved by the scientific research ethics committee at Kafr El-Sheikh University in Egypt, and the approval number was KFSIRB200-66. We obtained a written informed consent from all adults participating in this study. Our study did not include any vulnerable patient. Consent to participate: Before inclusion in the study, formal written informed consent was obtained from the included patients.

Figures

Fig. 1
Fig. 1
Study flow diagram.
See this image and copyright information in PMC

References

    1. Zeinhom, M. G., Elbassiouny, A., Mahmoud, A., Sherihan, M. & Ahmed, R. Ticagrelor versus clopidogrel in acute large – vessel ischemic stroke: a randomized controlled single – blinded trial. CNS Drugs 450 (0123456789). 10.1007/s40263-024-01080-5 (2024). - PMC - PubMed
    1. Zeinhom, M. G. et al. Predictors of the unfavorable outcomes in acute ischemic stroke patients treated with alteplase, a multi – center randomized trial. Sci. Rep. 1–9. 10.1038/s41598-024-56067-5 (2024). - PMC - PubMed
    1. Strbian, D. et al. Patient outcomes from symptomatic intracerebral hemorrhage after stroke thrombolysis. Neurology 77 (4), 341–348 (2011). http://n.neurology.org/content/77/4/341.abstract - PubMed
    1. Honig, A. et al. Hemorrhagic transformation in acute ischemic stroke: a quantitative systematic review. J. Clin. Med. 11(5) (2022). - PMC - PubMed
    1. Powers, W. J. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke A. Stroke 50, 344–418 (2019). - PubMed

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