Treatment of Hemorrhage After Thrombolysis Does Not Reduce Mortality Risk

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Shortening diagnosis and treatment time of sICH may be crucial in improving outcomes.
Shortening diagnosis and treatment time of sICH may be crucial in improving outcomes.

There is significant room for improvement in treating intracerebral hemorrhage following thrombolysis for ischemic stroke, according to findings published in JAMA Neurology.

In a retrospective study of 3894 patients in 10 stroke centers across the United States, Shadi Yaghi, MD, from the Department of Neurology at Brown University, and colleagues found that the treatment of symptomatic intracerebral hemorrhage (sICH) after thrombolysis was not associated with a reduced risk of in-hospital death or expansion of the hematoma.

They also found that response times in discovering and treating sICH were long: the median time from initiation of recombinant tissue plasminogen activator (rtPA) therapy to sICH diagnosis was 470 minutes (range, 30-2572 minutes), and the median time from diagnosis to treatment was 112 minutes (range, 12-628 minutes).

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“Shortening the time to diagnosis and treatment may be a key variable in improving outcomes of patients with sICH,” the authors wrote. Although sICH is an infrequent complication of thrombolysis, it is the most serious, with a mortality rate approaching 50%.

While the study may be “underpowered to detect the benefit of any particular treatment, it highlights the complexity of the patient population, treatment options, and differences in clinical practice for sICH across the United States,” wrote Tiffany Cossey, MD and Nicole Gonzales, MD, from the Department of Neurology at the University of Texas Medical School, in an accompanying editorial. “Importantly, this study informs future prospective work, provides data that call for a reevaluation of our treatment of postthrombolysis sICH, and calls on the stroke community to reevaluate what an acceptable risk of thrombolysis should be,” they added.

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