Comparison of the risk factors of hemorrhagic transformation between large artery atherosclerosis stroke and cardioembolism after intravenous thrombolysis

Abstract

ObjectiveHemorrhagic transformation (HT) is a common complication of ischemic stroke after intravenous thrombolytic therapy (IVT), especially in cardioembolism (CE) and large artery atherosclerosis stroke (LAA) patients. Whether there are different risk factors for HT in LAA and CE patients remains unclear. The aim of this study was to explore the differences in risk factors for HT in patients with LAA and CE after IVT. Patients and methodsA retrospective analysis was conducted on LAA and CE patients who were treated with intravenous tissue plasminogen activator at our hospital from 2015 to 2019. Demographic and clinical information was collected, and HT was evaluated within 72 h after stroke onset. Lipids levels, albumin, uric acid (UA), platelet volume indices, as well as potential predictors of HT were analyzed between patients with and without HT (non-HT group). ResultsA total of 247 patients (168 LAA and 79 CE) were included in the study, out of which 62 (25.1 %) had HT. HT was more prevalent in the CE subgroup (30.3 %) than in the LAA subgroup (22.6 %). Compared with non-HT, patients with HT showed a higher rate of the previous stroke, baseline NIHSS scores, and mean platelet volume (MPV), lower levels of platelet count (PC), triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), albumin, and UA (P < 0.05). Multivariate logistic regression analysis showed that lower LDL (OR = 0.547, 95 % CI 0.321–0.932, P = 0.027), and higher blood glucose (OR = 1.137, 95 % CI 1.015–1.247, P = 0.026) were independent risk factors for HT in LAA patients, while lower albumin (OR = 0.989, 95 % CI 0.977–1.000, P = 0.048), and lower PC(OR = 0.868, 95 % CI 0.754–0.989, P = 0.047) were independent risk factors for HT in CE patients. ConclusionPatients with different etiologies may have different risk factors of HT following IVT. Lower LDL-C and higher blood glucose are independent risk factors of LAA, while lower albumin and PC are independent risk factors of CE.