Risk factors of hemorrhagic transformation in acute ischaemic stroke : A systematic review and meta-analysis

Journal article


Sun, Jiacheng, Lam, Christina, Christie, Lauren, Blair, Christopher, Li, Xingjuan, Werdiger, Freda, Yang, Qing, Bivard, Andrew, Lin, Longting and Parsons, Mark William. (2023). Risk factors of hemorrhagic transformation in acute ischaemic stroke : A systematic review and meta-analysis. Frontiers in Neurology. 14, p. Article 1079205. https://doi.org/10.3389/fneur.2023.1079205
AuthorsSun, Jiacheng, Lam, Christina, Christie, Lauren, Blair, Christopher, Li, Xingjuan, Werdiger, Freda, Yang, Qing, Bivard, Andrew, Lin, Longting and Parsons, Mark William
Abstract

Background: Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)].

Methods: Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated.

Results: A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212–5.599, I2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, I2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970–7.591, I2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, I2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, I2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, I2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, I2 = 86.4%) were predictors of sICH after EVT.

Conclusion: Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=2689... identifier: CRD42021268927.

Keywordsstroke; risk factor; intracranial hemorrhage; hemorrhagic transformation; reperfusion therapy; intravenous thrombolysis; endovascular thrombectomy
Year2023
JournalFrontiers in Neurology
Journal citation14, p. Article 1079205
PublisherFrontiers Media S.A.
ISSN1664-2295
Digital Object Identifier (DOI)https://doi.org/10.3389/fneur.2023.1079205
PubMed ID36891475
Scopus EID2-s2.0-85149950730
PubMed Central IDPMC9986457
Open accessPublished as ‘gold’ (paid) open access
Page range1-15
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online20 Feb 2023
Publication process dates
Accepted31 Jan 2023
Deposited19 Jul 2023
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https://acuresearchbank.acu.edu.au/item/8z592/risk-factors-of-hemorrhagic-transformation-in-acute-ischaemic-stroke-a-systematic-review-and-meta-analysis

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