Factors Associated With Intracerebral Hemorrhage After Thrombolytic Therapy for Ischemic Stroke Pooled Analysis of Placebo Data From the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II Trials

Background and Purpose-A number of factors have been associated with postthrombolysis intracerebral hemorrhage, but these have varied across studies. Methods-We examined patients with acute ischemic stroke treated with intravenous tissue plasminogen activator within 3 hours of symptom onset who were enrolled in the placebo arms of 2 trials (Stroke-Acute Ischemic NXY Treatment [SAINT] I and II Trials) of a putative neuroprotectant. Early CT changes were graded using the Alberta Stroke Program Early CT Score (ASPECTS). Post-tissue plasminogen activator symptomatic intracerebral hemorrhage was defined as a worsening in National Institutes of Health Stroke Scale of >= 4 points within 36 hours with evidence of hemorrhage on follow-up neuroimaging. Good clinical outcome was defined as a modified Rankin scale of 0 to 2 at 90 days. Results-Symptomatic intracerebral hemorrhage occurred in 5.6% of 965 patients treated with tissue plasminogen activator. In multivariable analysis, symptomatic intracerebral hemorrhage was increased with baseline antiplatelet use (single antiplatelet: OR, 2.04, 95% CI, 1.07 to 3.87, P = 0.03; double antiplatelet: OR, 9.29, 3.28 to 26.32, P < 0.001), higher National Institutes of Health Stroke Scale score (OR, 1.09 per point, 1.03 to 1.15, P = 0.002), and CT changes defined by ASPECTS (ASPECTS 8 to 9: OR, 2.26, 0.63 to 8.10, P = 0.21; ASPECTS <= 7: OR, 5.63, 1.66 to 19.10, P = 0.006). Higher National Institutes of Health Stroke Scale was associated with decreased odds of good clinical outcome (OR, 0.82 per point, 0.79 to 0.85, P < 0.001). There was no relationship between baseline antiplatelet use or CT changes and clinical outcome. Conclusions - Along with higher National Institutes of Health Stroke Scale and extensive early CT changes, baseline antiplatelet use (particularly double antiplatelet therapy) was associated with an increased risk of post-tissue plasminogen activator symptomatic intracerebral hemorrhage. Of these factors, only National Institutes of Health Stroke Scale was associated with clinical outcome. (Stroke. 2009; 40: 3067-3072.)