Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage

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http://urn.fi/URN:NBN:fi:hulib-201611243093
Title: Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage
Author: Waltimo, Tuure
Other contributor: Helsingin yliopisto, Lääketieteellinen tiedekunta
University of Helsinki, Faculty of Medicine
Helsingfors universitet, Medicinska fakulteten
Publisher: Helsingfors universitet
Date: 2016
Language: eng
URI: http://urn.fi/URN:NBN:fi:hulib-201611243093
http://hdl.handle.net/10138/169763
Thesis level: master's thesis
Discipline: Neurology
Neurologia
Neurologi
Abstract: Background and purpose: Most guidelines for intravenous thrombolysis (IVT) in acute ischaemic stroke patients advise keeping systolic blood pressure (BP) below 180/105 mmHg prior to the bolus injection. Less is known about optimal management of BP thereafter. We assessed temporal changes in post-thrombolytic systolic BP values and their impact on development of symptomatic intracerebral hemorrhage (sICH). Methods: The study cohort included 1868 consecutive acute ischaemic stroke patients treated with IVT at the Helsinki University Central Hospital. sICH was defi ned according to the European Cooperative Acute Stroke Study II (ECASS-II) (primary outcome), National Institute of Neurological Disorders and Stroke, and Safe Implementation of Thrombolysis in Stroke criteria. We evaluated BP at admission, prior to IVT and at 2, 4, 8, 12, 24 and 48 h after thrombolysis. We used univariate and multivariable models to test the effect of BP at various time-points on development of post-thrombolytic sICH. Results: Prevalence of sICH in the cohort was 5.8% (ECASS-II). Patients with sICH had significantly higher systolic BP at several time-points after IVT compared with those without sICH (P < 0.01 at 2 and 4 h; P < 0.05 at 12 and 48 h). The odds ratios for development of sICH per 10 mmHg increase in BP were 1.14 [95% confi dence interval (CI), 1.03–1.25], 1.14 (95% CI, 1.03–1.25), 1.12 (95% CI, 1.01–1.23) and 1.12 (95% CI, 1.01–1.23), respectively. At 8 h, we observed a trend (P = 0.07) for ECASS-II and a significant effect (P < 0.05) for National Institute of Neurological Disorders and Stroke, and Safe Implementation of Thrombolysis in Stroke criteria. Thus, the only timepoint with no difference observed was 24 h. Conclusions: Patients with post-thrombolytic sICH have signifi cantly higher systolic BP at several time-points compared with patients without sICH.
Subject: Stroke
Thrombolysis
Blood pressure


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