Identification of factors associated with the development of symptomatic intracerebral hemorrhage (SICH) post recombinant tissue plasminogen activator (rtPA).

Thrombolytic therapy with rtPA has a known risk of SICH. Identification of factors with a significant association with the development of SICH post rtPA would enable us to identify patients who require more intensive neurological monitoring.

We performed a retrospective chart review of patients who received rtPA from 7/1/2014 to 3/31/2018 at University Hospital, Newark. SICH was defined as an intracranial hemorrhage that causes an increase in NIHSS score by ≥4 points within 7 days post rtPA. We analyzed various factors recorded at presentation such as presenting systolic blood pressure(SBP), diastolic blood pressure(DBP), blood glucose, NIHSS score, verify aspirin, presence of early infarct signs on Computed tomography (CT) Head, symptom duration, age, sex, platelet count, INR, weight, stroke subtype according to TOAST criteria and compared them between SICH and non-SICH groups. Patients who underwent thrombectomy and patients with neuroimaging negative for a stroke during hospitalization were excluded.

SICH rate in our cohort of 89 patients was 5.62%. Several factors such as blood glucose ≥185 mg/dL (OR, 14.25; 95% CI, 2.06-98.35; P 0.001), SBP≥190 (OR, 18.40; 95% CI, 1.92-176.56; P 0.007), DBP≥115 (OR, 8.42; 95% CI, 1.28-55.42; P 0.036), verify aspirin≤500 (OR, 10.53; 95% CI, 1.10-100.28; P 0.03) and presence of early infarct signs on CT Head (P 0.02), recorded upon a patient's presentation had a significant association with the development of SICH. There was no significant difference in the development of SICH with respect to other recorded factors (P>0.05).

We found that SBP≥190, DBP≥115, blood glucose≥185 mg/dL, verify aspirin≤500 and presence of early infarct signs on CT Head upon a patient's presentation have a significant association with SICH post rtPA. Patients with these risk factors should receive more intensive neurological monitoring.