Week 6: Management of Acute Stroke, part 3

#16: Remote or extraischemic ICH–an uncommon complication of stroke thrombolysis

  • This paper goes into the ECASS classification of hemorrhage after tPA: basically 4 classifications for hemorrhage within the infarct, vs remote parenchymal hemorrhage (PHr)
  • In patients given thrombolytics for acute MI, the rate of ICH is 0.3-0.8%, but in stroke patients, the hemorrhage rate in NON-infarcted brain is still 1.3-3.7%, several times higher.
  • This paper looked at data from 43k patients from the SITS-ISTR, an international stroke thrombolysis registry
  • Of all the post-tPA hemorrhage, about 1/3 was remote from the infarct (2.2% vs 5.3% within the infarct)
  • The way they did this analysis is a little goofy (they compared hemorrhagic infarct vs remote hemorrhage), but compared to those patients who had hemorrhage infarcts, the patients with remote hemorrhage were a little older, more female, and were more likely to have had a prior stroke. The paper goes on to say that maybe this is because the older ladies have amyloid angiopathy which makes them more likely to bleed.

So, interesting paper. The only thing is I’ve read it a couple times now and I still think the statistics are backwards compared to what would be clinically useful, like which patients should I be the most concerned about hemorrhage after tPA? And from reading this I’m not clear if that’s the elderly ladies or not.


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