J Korean Neurol Assoc.  2012 May;30(2):110-115.

Prediction of Hemorrhagic Transformation and Functional Outcome Using HAT Score in Acute Ischemic Stroke Patients Treated with Intravenous Alteplase

• Heo SH
• Yi SH
• Lee D
• Hwang KJ
• Jung YJ
• Park KC
• Ahn TB
• Yoon SS
• Chung KC
• Chang DI

Abstract

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.

Keyword

Acute stroke; Hemorrhage; Thrombolytic therapy; Tissue plasminogen activator

MeSH Terms

Atrial Fibrillation
Follow-Up Studies
Hemorrhage
Humans
Intracranial Hemorrhages
Logistic Models
Magnetic Resonance Imaging
National Institute of Neurological Disorders and Stroke
Neuroimaging
Prospective Studies
Retrospective Studies
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator