Treatment of Post-Thrombolysis sICH Doesn't Lower Mortality
(HealthDay News) — Treatment of thrombolysis-related symptomatic intracerebral hemorrhage (sICH) does not reduce in-hospital mortality, according to a study published online Oct. 26 in JAMA Neurology.
Shadi Yaghi, M.D., from the Columbia University Medical Center in New York City, and colleagues conducted a multicenter retrospective study at 10 primary and comprehensive stroke centers to better understand the natural history of thrombolysis-related sICH.
Overall, 128 patients (3.3 percent) of the 3,894 treated with intravenous recombinant tissue plasminogen activator (rtPA) within 4.5 hours after ischemic stroke symptoms onset had sICH. The researchers found that the median time from rtPA therapy initiation to sICH diagnosis was 470 minutes, and from sICH diagnosis to treatment was 112 minutes. The rates of in-hospital mortality and hematoma expansion were 52.3 and 26.8 percent, respectively. The sole factor associated with increased in-hospital mortality was code status change to comfort measures after sICH diagnosis, in the multivariable models (odds ratio, 3.6). Severe hypofibrinogenemia correlated with hematoma expansion and was seen in 36.3 and 25.0 percent of those without and with hematoma expansion, respectively (P = 0.01).
"In this study, treatment of post-thrombolysis sICH did not significantly reduce the likelihood of in-hospital mortality or hematoma expansion," the authors write. "Shortening the time to diagnosis and treatment may be a key variable in improving outcomes of patients with sICH."
Several authors disclosed financial ties to the medical device industry.