Study Identifies Risks Associated with Intravenous Thrombolysis Therapy in Patients with Prior Intracerebral or Subarachnoid Hemorrhage

Study results presented at the American Academy of Neurology (AAN) 2024 Annual Meeting demonstrate that patients with a history of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who receive intravenous thrombolysis (IVT) for acute ischemic stroke have more than triple the risk of developing symptomatic hemorrhage compared to those without this history. These results underscore the need for additional studies assessing the safety of IVT treatment for patients with a history of ICH and SAH and emphasize the need for careful clinical evaluation of the risks and benefits of IVT when considering it as a potential treatment in this patient population.

The prospective study included 20,369 individuals who were treated with IVT for acute ischemic stroke, 94 of whom had a history of ICH/SAH. Researchers collected data from Florida hospitals participating in the Get With the Guidelines-Stroke program between January 2019 and December 2022. The 94 individuals with a history of ICH/SAH were older, more likely to have dyslipidemia, atrial fibrillation, prior ischemic stroke, and antiplatelet drug use.

Results indicated that individuals with prior ICH/SAH:

• Were more likely to develop symptomatic ICH within 36 hours of IVT (7.5% of those with prior ICH/SAH vs 2.2% of those with no prior ICH/SAH; 3.6 odds ratio [OR], 1.6-7.8)
• Were less likely to be discharged to home or acute rehabilitation (55.3% of those with prior ICH/SAH vs 70.9% of those with no prior ICH/SAH; 0.5 OR, 0.3-0.8)
• Were less likely to ambulate independently at discharge (34.0% of those with prior ICH/SAH vs 49.1% of those with no prior ICH/SAH; 0.5 OR, 0.3-0.8)