Predicting a post-thrombolysis intracerebral hemorrhage: a systematic review

Authors

  • J. B. Echouffo-Tcheugui,

    1. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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  • M. Woodward,

    1. The George Institute for Global Health, Sydney, Australia
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  • A. P. Kengne

    Corresponding author
    1. The George Institute for Global Health, Sydney, Australia
    2. Department of Medicine, University of Cape Town & South African Medical Research Council, Cape Town, South Africa
    3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
    • Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Correspondence: Andre Pascal Kengne, South African Medical Research Council, PO Box 19070 Tygerberg, 7505 Cape Town, South Africa.

Tel.: +27 21 938 0529; fax: +27 21 938 0460.

E-mail: andre.kengne@mrc.ac.za

Summary

Objectives

Fear of an intracerebral hemorrhage (ICH) is a deterrent to the uptake of thrombolytic therapy, an evidence-based treatment for an acute ischemic stroke. Several characteristics associated with post-thrombolysis ICH have been identified, but their combined utility for risk stratification has yet to be clarified. We critically examined risk models to predict post-thrombolysis ICH, and evaluated their potential clinical utility.

Methods

MEDLINE and EMBASE (Inception to October 2012) were searched and bibliographies of retrieved articles examined. Inclusion and exclusion criteria of each study were reviewed. Eligible studies had to report on the development, validation or impact assessment of a model constructed to predict the occurrence of ICH after thrombolysis for an ischemic stroke.

Results

We identified 10 publications reporting on 13 post-thrombolysis ICH risk models, each developed from logistic regression. The number of participants/outcomes/predictors per model ranged from 89/45/4 to 27 804/558/7; age, glycemia and the NIH stroke scale score were common predictors. Models had modest-to-acceptable discriminatory ability (c-statistic ranging from 0.59 to 0.88) in the derivation sample and during external validation (conducted for three models). Calibration was acceptable in the three studies where it was assessed. Impact studies to evaluate the effect of adopting ICH risk models on clinical outcomes have not yet been conducted.

Conclusions

The development and clinical application of ICH risk scores remains a developing field. Extensive external validation and impact studies are needed to strengthen evidence regarding their utility for improving the selection of ischemic stroke victims for thrombolysis while mitigating risks of complications through post-thrombolysis ICH.

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