EAN 2023 | An autopsy study investigating hemorrhagic transformation in stroke
Laszlo Csiba, MD, PhD, DSci, University of Debrecen, Debrecen, Hungary, discusses new findings from body and brain autopsy of 700 stroke patients with and without thrombolysis. Ischemic stroke requires appropriate therapy, mainly through vessel-opening techniques like thrombolysis and mechanical thrombectomy. However, these interventions can lead to hemorrhagic transformation, a frequent complication of acute ischemic stroke that is especially common after thrombolytic therapy. A study conducted autopsies on patients who died after the intervention to determine the frequency and parameters influencing this complication. Surprisingly, the study revealed that more patients experienced hemorrhagic transformation between thrombolysis and death rather than during the first day. These results suggest that thrombolysis is not the main factor influencing hemorrhagic transformation since the half-life of alteplase is only some minutes. Therefore, hemorrhagic transformation between the first day and death was influenced by other factors. Understanding the factors influencing this complication, such as glucose levels and blood pressure, is crucial to preventing negative outcomes. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript (edited for clarity)
We know very well that stroke is a devastating disorder and number one (disorder) responsible for acquired handicaps. Everybody fears from the stroke because after a stroke, without appropriate therapy, it will devastate your health. The only efficient method is to open the vessel with the chemotherapy like TPA or mechanical thrombectomy. The brain contains 75% of water and any intervention including the thrombolysis and including mechanical thrombectomy, is associated with hemorrhagic transformation from ischemia, occlusion of the vessel, the tissue will be hemorrhagic...
We know very well that stroke is a devastating disorder and number one (disorder) responsible for acquired handicaps. Everybody fears from the stroke because after a stroke, without appropriate therapy, it will devastate your health. The only efficient method is to open the vessel with the chemotherapy like TPA or mechanical thrombectomy. The brain contains 75% of water and any intervention including the thrombolysis and including mechanical thrombectomy, is associated with hemorrhagic transformation from ischemia, occlusion of the vessel, the tissue will be hemorrhagic. This is a very severe problem. It can happen spontaneously, but it can also happen after therapy. And you know that it’s true that we have to perform CT after the intervention immediately (one day), it is mandatory. But what will happen between the first CT and the discharge of the patients from the hospital? If the patient has a silent hemorrhagic transformation, then you can discharge him or her with antithrombotic therapy and it can be dangerous. So, to know the frequency, the true frequency of the hemorrhagic complication is a difficult topic.
Therefore, we investigated the patients who were autopsied after the intervention and died at the hospital – what is the true frequency? What kind of parameters can influence this feared complication. It turned out that more patients will have hemorrhagic transformation between the thrombolysis and death than during the first day. We also investigated what kind of parameters can influence this complication. First everybody thought the thrombolysis itself was dangerous and it resulted in the higher rate of hemorrhagic transformation, but it is not true because the half-life of TPA is only some minutes. Therefore, the hemorrhagic transformation between the first day and death is caused by other unknown factors.
We investigated the effect of antithrombotic therapy before the stroke and after the first day, but we did not find any relation. So, our most important finding is that we have to focus on the period after the first day and discharge in order to know which other parameters; glucose, potassium, elevated blood pressure, or some other factor can influence this feared complication. Because if you know which factor has a bad influence on the outcome, then we can prevent it.
Read more...
