Renal Dysfunction Associated with Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis

J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104363. doi: 10.1016/j.jstrokecerebrovasdis.2019.104363. Epub 2019 Sep 6.

Abstract

Background and aim: Renal dysfunction (RD) is prevalent in patients with acute ischemic stroke requiring intravenous thrombolysis. The relationship between renal function and thrombolysis related intracranial hemorrhagic (ICH) complications is contradictory according to previous studies. The current study is to clarify whether RD could increase the risk of symptomatic intracranial hemorrhage (SICH) after recombinant tissue plasminogen activator (IV rtPA) in acute ischemic stroke patients.

Methods: In this observational study, acute ischemic stroke patients who received IV rtPA within 4.5 hours of symptom onset were retrospectively analyzed. Creatinine levels on admission served to calculate glomerular filtration rate (GFR) to estimate RD. SICH was defined with National Institute of Neurological Disorder and Stroke (NINDS, SICHNINDS) or European Cooperative Acute Stroke Study II (ECASS II, SICHECASSII) criteria. Association of RD with SICH was assessed using continuous GFR or binary GFR (RD defined as GFR < 90 ml/minute/1.73 m2).

Results: Of 312 patients included, the incidence of SICHNINDS was 7.69%, of SICHECASSII was 5.45%. Patients with RD had higher prevalence of SICHNINDS (12.80% versus 2.03%, P < .001) and SICHECASS II (9.15% versus 1.35%, P = .002). GFR as a continuous variable was associated with SICHNINDS (ORadjust = .97, P = .003), but not with SICHECASS II. GFR less than 90 ml/minute/1.73 m2 remained independently associated with SICHNINDS (ORadjust = 4.79, P = .016), and SICHECASS II (ORadjust = 2.99, P = .032) in multiple logistic regression analysis.

Conclusions: Renal function is independently associated with SICH after IV rtPA thrombolysis. RD is an independent predictor for both SICHNINDS and SICHECASS II. RD should be considered when evaluating the risk of intravenous thrombolysis with IV rtPA.

Keywords: Renal dysfunction; ischemic stroke; symptomatic intracranial hemorrhage; thrombolysis.

Publication types

  • Observational Study

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / physiopathology
  • China / epidemiology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / adverse effects*
  • Glomerular Filtration Rate*
  • Humans
  • Incidence
  • Intracranial Hemorrhages / chemically induced*
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / epidemiology
  • Kidney / physiopathology*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology
  • Kidney Diseases / physiopathology*
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Stroke / epidemiology
  • Stroke / physiopathology
  • Thrombolytic Therapy / adverse effects*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / adverse effects*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • PLAT protein, human
  • Tissue Plasminogen Activator