Incidence, Predictors, and Outcomes of Symptomatic Intracranial Hemorrhage after Tenecteplase in Acute Ischemic Stroke.

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2026-07-01 Epub Date: 2026-07-21 DOI:10.4103/aian.aian_6_26

Arpan Dutta, Uddalak Chakraborty, Subhadeep Gupta, Soumozit Banerjee, Chayan Mondal, Arnab Sarkar, Deep Das, Rahul Kumar, Shashvat M Desai, Ashutosh P Jadhav, Snehasis Das, Samir K Datta, Chinmoy Barik, Somnath Ghosh, Bichitra Biswas, Suprim Sadhukhan, Souvik Sen, Soumya Ghosh, Nitai C Mandal, Subhransu S Datta, Swapan Saren, Manimoy Bandyopadhyay, Biman K Ray

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Abstract

Background and objectives: Symptomatic intracranial hemorrhage (SICH) after thrombolysis is a major safety concern in the management of acute ischemic stroke (AIS). This study evaluates the predictors and outcomes of SICH among AIS patients receiving tenecteplase.

Methods: This multicenter retrospective observational study included AIS patients who received tenecteplase between December 2021 and June 2024 at 41 Swasthya Ingit Telestroke Network hospitals in West Bengal, India.

Results: Of 1,463 tenecteplase-treated AIS patients, 68 (4.64%) developed SICH. Mixed-effects multivariable logistic regression showed that age >61 years (adjusted odds ratio [aOR] 2.37, 95% confidence interval [CI] 1.38-4.07), hyperlipidemia (aOR 2.84, 95% CI 1.28-6.31), atrial fibrillation (aOR 4.84, 95% CI 1.86-12.59), smoking (aOR 2.55, 95% CI 1.30-5.00), systolic blood pressure >150 mmHg on admission (aOR 2.09, 95% CI 1.25-3.48), and a baseline National Institutes of Health Stroke Scale (NIHSS) score >9 (aOR 1.71, 95% CI 1.03-2.86) were associated with higher odds of SICH. An Alberta Stroke Program Early CT Score (ASPECTS) <8 was an additional risk factor among patients with middle cerebral artery (MCA) territory infarcts (aOR 3.32, 95% CI 1.70-6.50). Among the 313 patients who underwent angiography, the presence of large vessel occlusion was also associated with increased odds of SICH (aOR 5.65, 95% CI 1.86-17.19). In the SICH group, significantly fewer patients achieved a favorable outcome (mRS 0-2) at 90 days (7.4% vs 60.6%, P < 0.001), and all-cause mortality was significantly higher (79.4% vs 12.3%, P < 0.001).

Conclusions: SICH after tenecteplase use in AIS is associated with increased morbidity and mortality. Older age, higher baseline NIHSS scores, elevated systolic blood pressure on admission, smoking, hyperlipidemia, atrial fibrillation, lower ASPECTS, and large vessel occlusion are associated with a higher risk of SICH in tenecteplase-treated AIS patients.

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急性缺血性脑卒中患者服用替奈普酶后症状性颅内出血的发生率、预测因素和结局。

背景和目的：溶栓后症状性颅内出血（siich）是急性缺血性卒中（AIS）治疗中的一个主要安全问题。本研究评估了接受替尼替普酶治疗的AIS患者发生SICH的预测因素和预后。方法：这项多中心回顾性观察研究纳入了印度西孟加拉邦41家Swasthya Ingit中风网络医院2021年12月至2024年6月期间接受替奈普酶治疗的AIS患者。结果：1463例接受tenectepase治疗的AIS患者中，68例（4.64%）发生SICH。混合效应多变量logistic回归分析显示：年龄> ~ 61岁（调整比值比[aOR] 2.37, 95%可信区间[CI] 1.38 ~ 4.07）、高血脂（aOR 2.84, 95% CI 1.28 ~ 6.31）、房颤（aOR 4.84, 95% CI 1.86 ~ 12.59）、吸烟（aOR 2.55, 95% CI 1.30 ~ 5.00）、入院时收缩压>150mmhg (aOR 2.09, 95% CI 1.25 ~ 3.48)，以及基线美国国立卫生研究院卒中量表（NIHSS）评分>9 （aOR 1.71, 95%可信区间[CI] 1.38 ~ 4.07）。95% CI 1.03-2.86)与SICH的高发生率相关。结论：在AIS患者中使用替奈普酶后，SICH与发病率和死亡率增加有关。年龄较大、NIHSS基线评分较高、入院时收缩压升高、吸烟、高脂血症、心房颤动、下肢和大血管闭塞与接受tenectepase治疗的AIS患者发生SICH的高风险相关。

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来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.