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Brain Trauma
Table 1: Score Assignments in the HAT Score Table 3: Score Assignments in the Score Reported by the
Multicenter Stroke Survey Scale
History of Diabetes or Admission Hyperglycemia >200mg/dl
No 0 Multicenter Stroke Survey Scale (n=481)
Yes 1
Age (years)
Pre-treatment NIHSS
≤60 0
<15 0
>60 1
15–20 1
Pre-treatment NIHSS
≥20 2
≤10 0
Presence of Hypodensity on Initial Head CT Scan >10 1
No 0
Admission Glucose (mg/dl)
<
1
⁄3 of MCA territory 1
≤150 0
>
1
⁄3 of MCA territory 2
>150 1
CT = computed tomography; HAT = Hemorrhage After Thrombolysis; MCA = middle cerebral
Platelet Count
artery; NIHSS = National Institute of Health Stroke Scale.
>150,000 0
≤150,000 1
Table 2: Risk of Post-thrombolytic Hemorrhage Based
on the HAT Score in a Combined Analysis of NINDS and
NIHSS = National Institute of Health Stroke Scale.
Prospective Cohorts (n=400)
Table 4: Risk of Post-thrombolytic Hemorrhage
Based on the Score Reported by the Multicenter
Cumulative Number of Total ICH Rate SICH Rate
Stroke Survey Scale
Score Patients (%) (%)
0 153 6 2
Cumulative Number of asICH Rate SICH Rate PH Rate
1 121 16 5
Score Patients (%) (%) (%)
2842310
0390 0 0
333 6 5
1 163 5 5 3
>3 9 78 44
2 192 11 4 5
HAT = Hemorrhage After Thrombolysis; ICH = intracerebral hemorrhage; NINDS = National ≥3 87 20 18 18
Institute of Neurological Disorders and Stroke; SICH = symptomatic intracerebral hemorrhage.
asICH = asymptomatic intracerebral hemorrhage; PH = parenchymal hemorrhage;
SICH = symptomatic intracerebral hemorrhage.
instance, in ECASS III the rate of SICH was 2.4% in the rt-PA group using an independent predictor of ICH in multivariate analysis.
20,30
However, in
the ECASS III protocol definition, but 7.9% using the NINDS definition.
10
the Multicenter rt-PA study the association of age and ICH disappeared
Studies evaluating predictors of post-thrombolytic ICH have used various when baseline CT and laboratory changes were included in the
definitions, which may account for some of the variability in identified statistical model. The variability between risk factors across studies is
predictors of post-thrombolysis ICH between studies. likely in part due to differences in baseline patient characteristics and
statistical modeling between and within studies, as well as the
Risk Factors for Post-thrombolysis increased power of pooled analysis of multiple studies.
Intracerebral Hemorrhage
Lansberg et al. recently performed a systematic review of the literature Despite the identification of numerous factors associated with an
and reported several risk factors consistently associated in multiple increased risk for post-thrombolysis ICH, it is unclear how to incorporate
studies with post-thrombolysis SICH.
12
In 12 studies that met their these factors into a risk assessment for individual stroke patients.
inclusion criteria, early computed tomography (CT) hypodensity, Factors such as the presence or extent of early changes on
elevated serum glucose or history of diabetes, and symptom severity as neuroimaging, age, elevated glucose or diabetes, and degree of
defined by the NIHSS were the factors most consistently associated with neurological impairment defined by NIHSS may all, to some extent,
an increased risk of post-thrombolysis SICH.
12–22
Numerous other risk reflect stroke severity and therefore not be truly independent variables.
factors have been reported in individual studies, including advanced Even when independent, it is difficult to quantify the incremental additive
age, longer time to treatment, high systolic blood pressure, low platelet risk associated with the presence of multiple risk factors in the individual
count, history of congestive heart failure, low plasminogen activator patient. The development of clinical risk scores attempts to fill this need.
inhibitor levels, prior antiplatelet use, non-smoking status, low-density Two recent publications have incorporated some of the above variables
lipoprotein levels, imaging characteristics on magnetic resonance into scoring systems to better predict SICH and allow risk stratification of
imaging (MRI), and deviations from treatment protocols.
12,19–21,23–29
patients receiving thrombolytic therapy for acute ischemic stroke.
31,32
However, the association between these factors and risk for ICH
remains uncertain given the variable results across studies. For The Hemorrhage After Thrombolysis Score
instance, advanced age was independently identified to increase SICH The Hemorrhage After Thrombolysis (HAT) Score was developed by
risk in a secondary analysis of ECASS II.
19
Age was also identified as a analyzing the reported odds ratios from publications of predictors of
potential risk factor for SICH in the pooled analysis of the NINDS, ECASS, post-thrombolysis ICH.
31
Receiver–operator characteristic (ROC) curves
and ATLANTIS trials and by the Multicenter rt-PA Stroke Study Group as were developed and the predictive ability of various combinations of
40 US NEUROLOGY
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