Scores Help Identify Stroke Patients at Risk of Brain Bleed

By: MICHELE G. SULLIVAN, Cardiology News Digital Network – 02/09/12.

NEW ORLEANS – Two new risk assessment scores predicted the likelihood of a symptomatic intracranial hemorrhage after ischemic stroke treatment with more than 70% accuracy.

Predictive rules such as these are important because there is still no large-scale prospective study that clearly identifies which patients with ischemic stroke are more likely to develop a brain bleed after treatment with intravenous tissue plasminogen activator (TPA), Dr. Bijoy Menon said at the International Stroke Conference.

Dr. Menon, a clinical stroke fellow at the University of Calgary (Alta.), and his colleagues developed a 101-point score based on data extracted from the Get With The Guidelines stroke cohort. The cohort consisted of 10,242 patients with ischemic stroke who received TPA within 3 hours of the onset of stroke symptoms. A derivation cohort comprised 70% of the group; the rule was then validated in the remaining 30%.

The cohort’s mean age was 69 years. All patients experienced a moderate to severe ischemic stroke, with a mean National Institutes of Health Stroke Scale (NIHSS) score of 11. They received TPA at a mean of 1.35 hours after symptom onset.

About 5% of the group (496 patients) experienced a symptomatic intracranial hemorrhage (ICH), which the investigators defined as neurologic worsening within 36 hours of TPA administration.

In a multivariate regression model, Dr. Menon and his coinvestigators found six patient characteristics that were significantly associated with a brain bleed. They assigned each of these characteristics a point spread based on the range of measurements:

• Age. From age 60 years or younger (8 points) to older than 80 (17 points). Read Full Article