Clinical and Laboratory Factors predisposing to hemorrhagic conversion of ischemic stroke after thrombolysis (P6.240)

BACKGROUND:Factors associated with hemorrhagic conversion (HC) after IV rtPa administration for acute ischemic stroke (AIS) remain nebulous. Advanced age, Higher NIHSS score, longer time to recanalization, early head CT changes and higher glucose level are among factors that have been shown to be independent predictors for HC post IV thrombolysis. This study investigates additional laboratory and clinical findings associated with HC in stroke patients who received IV rtPA and/or intra-arterial (IA) thrombolysis. METHODS:A retrospective chart review of patients recieving IV rtPA and/or IA thrombolysis for AIS at high volume comprehensive stroke center from 09/2009 till 04/2014 was undertaken. Among 268 patients, 88 patients had HC noted on follow-up imaging studies, 25 (5.5[percnt]) of them being symptomatic based on NINDS trial definition. In addition to demographic data such as age and gender, patient’s INR, creatinine, albumin, lipid panel, blood glucose, hemoglobin A1C and their admission NIHSS was recorded and the mean values were compared between the group with HC and non-bleeders. T-test and logistic regression was performed. RESULTS:Mean age (p=0.025), INR (p=0.027), NIHSS (p<0.0001), fasting blood glucose (p=0.01) and hemoglobinA1c (p=0.039) were significantly higher on those with HC, while lower mean albumin (p<0.0001), LDL (p=0.028) and total cholesterol (p=0.021) were associated with hemorrhagic conversion. Mean creatinine and triglyceride levels were not significantly different between groups. Using logistic regression modeling, higher NIHSS and lower albumin were associated with hemorrhagic conversion; where approximately 1 point increase in NIHSS or 1 mg/dL decrease in serum albumin result in about 10[percnt] and 20[percnt] increase in the risk of HC respectively. CONCLUSIONS: Based on logistic regression modeling, higher NIHSS and lower serum albumin were associated with HC in AIS patients who received IV rtPA and/or intra-arterial (IA) thrombolysis. Higher HbA1c and lower LDL levels were not found to be associated with higher risk of hemorrhagic conversion. Disclosure: Dr. Mowla has nothing to disclose. Dr. Kamal has nothing to disclose. Dr. Shirani has nothing to disclose. Dr. Sawyer has nothing to disclose. Dr. Ching has nothing to disclose. Dr. McMurtray has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Li has nothing to disclose. Dr. Farooq has nothing to disclose. Dr. Singh has nothing to disclose. Dr. AbdelRazek has nothing to disclose. Dr. Mehla has nothing to disclose. Dr. Crumlish has nothing to disclose. Dr. Mehta has received personal compensation for activities with Biogen Idec, Teva Neuroscience, and the Gerson Lehrman Group as a as a speaker and/or consultant.