Prior Asymptomatic Intraparenchymal Hemorrhage Does Not Increase the Risk for Intracranial Hemorrhage after Intravenous Thrombolysis (P6.239)

BACKGROUND: The NINDS Trial demonstrated the efficacy of intravenous (IV) recombinant tissue plasminogen activator (rtPA) in improving neurologic outcome in patients presenting with acute ischemic strokes. Patients that had a prior history of intracranial hemorrhage (ICH) were excluded from this trial, possibly due to a hypothetical increase in the subsequent bleeding risk. Thus there is little data available against or in favor of the use of IV rtPA in patients with prior intracranial hemorrhage. OBJECTIVE: To determine the safety of IV rtPA in such patients through a retrospective hospital based study along with a review of the previous literature. DESIGN/METHODS: We reviewed the brain imaging of patients who received IV rtPA at our comprehensive stroke center from January 2006 to April 2014 for evidence of prior ICH at the time of rtPA administration. Their outcomes were determined in terms of subsequent development of symptomatic ICH as defined by the NINDS trial. RESULTS: Brain imaging for 637 patients was reviewed. A total of 26 patients showed evidence of prior ICH at the time of IV thrombolysis, all intraparenchymal. One patient (3.8[percnt]) developed subsequent symptomatic ICH within 24 hours of the administration of IV rtPA in an area distant from the location of the prior bleed. CONCLUSIONS: In comparison with the rate of symptomatic ICH reported in the NINDS trial (6.4[percnt]), patients with a history of asymptomatic intraparenchymal hemorrhage that presented with an acute ischemic stroke did not show an increased risk of developing symptomatic intracranial hemorrhage after IV thrombolysis (p Disclosure: Dr. AbdelRazek has nothing to disclose. Dr. Mowla has nothing to disclose. Dr. Zimmer has nothing to disclose. Dr. Elsadek has nothing to disclose. Dr. Abdelhamid has nothing to disclose. Dr. Elsadek has nothing to disclose. Dr. Kavak has nothing to disclose. Dr. Farooq has nothing to disclose. Dr. Kamal has nothing to disclose. Dr. Crumlish has nothing to disclose. Dr. Shirani has nothing to disclose. Dr. Sawyer has nothing to disclose.