High red blood cell distribution width levels could increase the risk of hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients.

Hongyang Fan,Xiaojie Liu,Sai Li,Yan Zhu,Xiaojia Tang,Yingzhu Chen,Yuxia Song,Haili Wang,Jun Li,Peipei Liu,Yuhan Luo

doi:10.18632/aging.203465

Abstract

The association between the red blood cell distribution width (RDW) and hemorrhagic transformation (HT) after thrombolysis in acute ischemic stroke patients remains inconclusive. Our study aimed to assess whether high RDW levels are associated with the occurrence of HT after thrombolysis. Data were consecutively collected and retrospectively analyzed for stroke patients treated with thrombolysis between 1 January 2017 and 31 December 2019. The primary outcomes were the occurrence of HT and symptomatic HT. Among the 286 patients enrolled, 36 (12.6%) developed HT and15 (5.2%) were classified as symptomatic HT. Patients with high RDW levels were associated with a higher percentage of HT and symptomatic HT (P<0.05). The RDW levels in the HT and symptomatic HT groups were also greater compared with the no-HT group (P<0.001). Multivariable logistic regression analysis revealed that high RDW levels were independently associated with an increased risk of HT (adjusted odds ratio 2.5, 95 % CI, 1.74–3.83 P < 0.001). In conclusion, we found that high RDW levels may be an independent predictor of HT in stroke patients after thrombolysis.

Highlights

Stroke is the leading cause of death and disabilityadjusted life-years in China [1]
A total of 306 Acute ischemic stroke (AIS) patients treated with recombinant tissue plasminogen activator (rt-PA) within 4.5 h of symptom onset from Northern Jiangsu People's Hospital between 1 January 2017 and 31 December 2019 were selected to participate in this study. 20 patients were later excluded because of following reasons: malignant tumor (n =2), autoimmune diseases (n=3), lack of followup computed tomography scan (n=10), and 5 patients without red blood cell distribution width (RDW) values
Results from univariable regression analyses in this study showed that the effect of baseline National Institutes of Health Stroke Scale (NIHSS) score, admission RDW level, platelet counts on the Symptomatic hemorrhagic transformation (sHT) in AIS patients treated by intravenous thrombolysis were significant (Table 3)

Summary

Introduction

Stroke is the leading cause of death and disabilityadjusted life-years in China [1]. Acute ischemic stroke (AIS) is the third most common cause of disability and mortality after cardiovascular diseases and cancer [2]. Hemorrhagic transformation (HT) is defined as bleeding into an area of ischemic brain after stroke, and appears in 10% to. 40% of acute ischemic stroke cases [4, 5], HT contributes to increased disability and mortality risk [6], and is believed to be either a part of the natural course of AIS or a common complication of intravenous thrombolytic therapy [7, 8]. Intravenous rt-PA therapy can induce or increase the risk for hemorrhagic transformation of ischemic lesions [9]. HT limits the use of intravenous thrombolysis (IVT), increases the risk of functional dependence and decreases the benefit-risk ratio of IVT treatment

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Conclusion