Medical Journal of The Islamic Republic of Iran (MJIRI)

  Background: Thrombolytic therapy is the only approved treatment for acute cerebral ischemia. The hemorrhagic transformation is the greatest complication of this treatment, which may occur after recanalization of occluded artery. The aim of this study was to determine factors associated with clinical improvement and worsening in patients with acute ischemic stroke treated with intravenous thrombolysis.

  Methods: Thirty seven patients who were treated with intravenous thrombolysis between August 2010 and August 2012 who had the inclusion criteria were studied. In this prospective study, all of the admitted patients in stroke unit, monitored for at least 48 hours. We registered all patients’ information in a stroke data registry and followed them for at least 6 months.

  Results: Thirty seven patients with acute ischemic stroke who treated with recombinant tissue plasminogen activator (r-TPA) were studied. There were hemorrhagic transformations in 9 (24%) patients. Seven of them (18%) revealed intracerebral hemorrhages (ICH) within the control brain CT after 24 hours without any deterioration of neurologic symptoms (asymptomatic ICH). Although outcomes of patients with symptomatic post r- TPA hemorrhages were worse than non-hemorrhagic post r-TPA patients, there were no significant differences between asymptomatic post r-TPA hemorrhages and non-hemorrhagic post r-TPA patients, according to the National Institutes of Health Stroke Scale (NIHSS) at admission (p = 0.2), after 24 hours (p= 0.07) and after 7 days (p= 0.06) post treatment.

  Conclusion: If the r-TPA protocol is followed carefully, the risk of symptomatic hemorrhage is low (about 7%). Taking r-TPA was feasible and safe in our study population thus, it can be applied for other Iranian patients.