A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke.

IF 2.5 Q2 PERIPHERAL VASCULAR DISEASE
International Journal of Vascular Medicine Pub Date : 2021-12-06 eCollection Date: 2021-01-01 DOI:10.1155/2021/4244267
Sneha E Thomas, Noorine Plumber, Priyanka Venkatapathappa, Vasavi Gorantla
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引用次数: 15

Abstract

Acute ischemic strokes (AIS) and hemorrhagic strokes lead to disabling neuropsychiatric and cognitive deficits. A serious and fatal complication of AIS is the occurrence of hemorrhagic transformation (HT). HT is cerebral bleeding that occurs after an ischemic event in the infarcted areas. This review summarises how specific risk factors such as demographic factors like age, gender, and race/ethnicity, comorbidities including essential hypertension, atrial fibrillation, diabetes mellitus, congestive heart failure, and ischemic heart disease along with predictors like higher NIHSS score, larger infarction size, cardioembolic strokes, systolic blood pressure/pulse pressure variability, higher plasma glucose levels, and higher body temperature during ischemic event, lower low-density lipoprotein and total cholesterol, early ischemic changes on imaging modalities, and some rare causes make an individual more susceptible to developing HT. We also discuss few other risk factors such as the role of blood-brain barrier, increased arterial stiffness, and globulin levels in patients postreperfusion using thrombolysis and mechanical thrombectomy. In addition, we discuss the implications of dual antiplatelet therapy and the length of treatment in reference to the incidence of developing HT. Current research into inflammatory mediators and biomarkers such as Cyclooxygenase-2, matrix metalloproteinases, and soluble ST2 and their potential role as treatment options for HT is also briefly discussed. Finally, this review calls for more research into use of dual antiplatelet and the timing of antiplatelet and anticoagulant use in reference to hemorrhagic transformation.

急性缺血性脑卒中患者出血转化的危险因素及预测因素综述。
急性缺血性中风(AIS)和出血性中风导致致残性神经精神和认知缺陷。出血性转化(HT)是AIS的一个严重和致命的并发症。HT是在梗死区域发生缺血事件后发生的脑出血。这篇综述总结了特定的危险因素,如人口统计学因素,如年龄、性别和种族/民族,合并症,包括原发性高血压、心房颤动、糖尿病、充血性心力衰竭和缺血性心脏病,以及预测因素,如较高的NIHSS评分、较大的梗死面积、心栓性中风、收缩压/脉压变异性、较高的血糖水平和缺血性事件期间较高的体温,较低的低密度脂蛋白和总胆固醇,早期缺血性影像学改变,以及一些罕见的原因使个体更容易发生HT。我们还讨论了其他一些危险因素,如血脑屏障的作用,动脉僵硬度增加,以及使用溶栓和机械取栓的患者灌注后的球蛋白水平。此外,我们讨论了双重抗血小板治疗的意义和治疗时间的长短,参考发生HT的发生率。本文还简要讨论了炎症介质和生物标志物(如环氧化酶-2、基质金属蛋白酶和可溶性ST2)的研究现状及其作为HT治疗方案的潜在作用。最后,这篇综述呼吁对双重抗血小板药物的使用以及抗血小板和抗凝药物的使用时机进行更多的研究,以参考出血转化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Vascular Medicine
International Journal of Vascular Medicine PERIPHERAL VASCULAR DISEASE-
CiteScore
3.50
自引率
0.00%
发文量
7
审稿时长
16 weeks
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