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Journal of the Korean Neurological Association 2012;30(2): 110-115.
정맥내 Alteplase를 사용한 급성허혈뇌졸중환자에서 HAT점수를 이용한 출혈변환과 기능예후의 예측
허성혁, 이상훈 이도경 a 황경진 a 정유진 a 박기정 안태범 윤성상 정경천 장대일
경희대학교 의과대학 신경과학교실, 경희대학교 대학원 a
Prediction of Hemorrhagic Transformation and Functional Outcome Using HAT Score in Acute Ischemic Stroke Patients Treated with Intravenous Alteplase
Sung Hyuk Heo
Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
Background: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients.
Methods: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36?hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics.
Results: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke - Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3?months, and mortality at 3?months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001).
Conclusions: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome. Key Words: Acute stroke, Hemorrhage, Thrombolytic therapy, Tissue plasminogen activator