Table 5.
Main risk factors and risk markers associated with HT.
| Study population | Bleeding type | Odds ratio | |
|---|---|---|---|
| A. Risk factors from RCT | |||
| IV thrombolysis (0.9 mg/kg Alteplase) vs. placebo (14, 16) | Any ischemic stroke | sICH | From 9.9* to 10.7* |
| IA prourokinase or urokinase (35) | Large vessel occlusion | sICH | 4.4* |
| IV thrombolysis (0.9 mg/kg) vs. placebo (36) | Any ischemic stroke with unknown onset and FLAIR/DWI mismatch on MRI | sICH | 5* |
| Mechanical thrombectomy 6-24 h (35, 37–47) | Large vessel occlusion and radiological mismatch | sICH | From 1.75 to 2 |
| Sonothrombolysis + IVT vs. IVT (48) | Any ischemic stroke | sICH | 1.47 |
| Use of stent retriever vs. direct aspiration (49) | Large vessel occlusion referred for thrombectomy | sICH | 1.23 |
| IV Tenecteplase (0.4 mg/kg) vs. Alteplase (0.9 mg/kg) (50) | Any ischemic stroke | sICH | 1.16 |
| IV Tenecteplase (0.25 mg/kg) vs. Alteplase (0.9 mg/kg) (40) | Large vessel occlusion referred for thrombectomy | sICH | 1 |
| IV Desmoteplase (62.5–125 μg/kg) vs. Alteplase (0.9 mg/kg) (41) | Any ischemic stroke | sICH | 1.5 |
| Mechanical thrombectomy within 6 h (19) | Large vessel occlusion | sICH | 1.06 |
| MT + Neretinide vs. MT (51) | Large vessel occlusion | sICH | 0.8 |
| MT alone vs. IVT+MT (52) | Large vessel occlusion | sICH | 0.7 |
| IVT (0.6 mg/kg) vs. IVT (0.9 mg/kg) (53) | Any ischemic stroke | sICH | 0.5* |
| B. Risk markers from retrospective studies: clinical and biological markers and pre-stroke medication | |||
| Baseline | |||
| Renal Impairment (54, 55) | Any ischemic stroke treated by IVT | Heterogeneous definitions of intracerebral hemorrhage and neurological deterioration | 2.79*; 2.08* |
| Any antiplatelet agent (54) | 2.08* | ||
| Congestive heart failure (54) | 1.96* | ||
| Atrial fibrillation (54) | 1.86* | ||
| Age (54) | 1.78* | ||
| Statin (54) | 1.72* | ||
| NIHSS (54) | 1.55* | ||
| Diabetes (54) | 1.54* | ||
| Ischemic heart disease (54) | 1.54* | ||
| Prior hypertension (54) | 1.5* | ||
| Glucose (54) | 1.10* | ||
| Smoking (54) | 0.7* | ||
| Triiodothyronine (56) | Any ischemic stroke | ICH | 3.46* |
| MMP-9 (57) | Ischemic stroke treated by MT | ICH | 2.48* |
| Neutrophil-to-lymphocyte ratio (58) | Any ischemic stroke treated by IVT | sICH | 2.08* |
| Fibrinogen decrease (59) | Any ischemic stroke treated by IVT | sICH | 1.92* |
| Bilirubin (60) | Ischemic stroke treated by MT | sICH | 1.36* |
| NIHSS (61) | Ischemic stroke treated by MT | sICH | 1.089* per point |
| Age (61) | 1.028* per year | ||
| Onset-to-end procedure time (61) | 1.00* per min | ||
| Platelet count (54, 62) | Any ischemic stroke treated by IVT | sICH, ICH | From 0.47* to 0.86 |
| Uric acid (63, 64) | Ischemic stroke treated by MT; any ischemic stroke | ICH | From 0.33* to 0.43* |
| Absolute Eosinophil Count ≥ 0.11 × 109/l (65) | Any ischemic stroke treated by IVT | ICH | 0.22* |
| Subacute phase | |||
| Clinical-genetic (66) | Any ischemic stroke treated by IVT | Parenchymal hemorrhage | 5.16* |
| 24 h arterial stiffness index (67) | Any ischemic stroke treated by OVT or MT | ICH | 1.9* |
| 24 h blood pressure variability (68) | Large vessel occlusion referred for MT | sICH | 1.71* |
| C. Risk markers from retrospective studies: imaging | |||
| Blood-brain barrier permeability (69) | Ischemic stroke treated by IVT or MT | ICH | 45.4* |
| Blood-brain barrier disruption after MT (70) | Ischemic stroke treated by MT | ICH | 25.3* |
| >10 microbleeds on MRI (71) | Any ischemic stroke treated by IVT | sICH | 5.55* |
| MT with ASPECTS 0–4 (72) | Ischemic stroke treated by MT in HERMES | sICH | 3.94 |
| Lower ASPECTS score (54) | Any ischemic stroke treated by IVT | Heterogeneous definitions of intracerebral hemorrhage and neurological deterioration | 3.46* |
| Visible lesion on CT (54) | 2.39* | ||
| Leukoaraiosis (54) | 2.45* | ||
| ASPECTS score (73) | Ischemic stroke treated by MT | PH | 1.87* |
| Intracranial calcifications on CT (74) | Non-cardiogenic ischemic strokes treated by IVT | ICH | 1.504* |
| Procedure time (MT) (75) | Ischemic stroke treated by MT | sICH | 1.43* per 30 mn |
| D. Risk markers from retrospective studies: composite scores | |||
| Study population | Bleeding type | Area under the curve | |
| IER-SICH nomogram (61) | Ischemic stroke treated by MT | sICH | 0.733* |
| TAG score (76) | 0.79* | ||
| HAT score (77) | Any ischemic stroke treated by IVT without MT | sICH | 0.769* |
ASPECTS: Alberta Stroke Program Early CT score; CT: Computed Tomography; HAT: Hemorrhage After Stroke; ICH: Intracerebral Hemorrhage; IER-SICH: Italian Registry of Endovascular Stroke Treatment in Acute Stroke Symptomatic Intracerebral Hemorrhage score; IV: Intravenous; IVT: Intravenous Thrombolysis; MRI: Magnetic Resonance Imaging; MT: Mechanical Thrombectomy; PH: Parenchymal Hemorrhage; sICH: symptomatic intracerebral hemorrhage; TAG: TICI-ASPECTS-glucose.
Risk markers and risk factors are ordered by odds ratio.
*
Statistically significant.