Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator

Bijoy K. Menon, Jeffrey L. Saver, Shyam Prabhakaran, Mathew Reeves, Li Liang, Daiwai M. Olson, Eric D. Peterson, Adrian F. Hernandez, Gregg C. Fonarow, Lee H. Schwamm, Eric E. Smith

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: There are few validated models for prediction of risk of symptomatic intracranial hemorrhage (sICH) after intravenous tissue-type plasminogen activator treatment for ischemic stroke. We used data from Get With The Guidelines-Stroke (GWTG-Stroke) to derive and validate a prediction tool for determining sICH risk. METHODS-: The population consisted of 10 242 patients from 988 hospitals who received intravenous tissue-type plasminogen activator within 3 hours of symptom onset from January 2009 to June 2010. This sample was randomly divided into derivation (70%) and validation (30%) cohorts. Multivariable logistic regression identified predictors of intravenous tissue-type plasminogen activator-related sICH in the derivation sample; model β coefficients were used to assign point scores for prediction. RESULTS-: sICH within 36 hours was noted in 496 patients (4.8%). Multivariable adjusted independent predictors of sICH were increasing age (17 points), higher baseline National Institutes of Health Stroke Scale (42 points), higher systolic blood pressure (21 points), higher blood glucose (8 points), Asian race (9 points), and male sex (4 points). The C-statistic was 0.71 in the derivation sample and 0.70 in the independent internal validation sample. Plots of observed versus predicted sICH showed good model calibration in the derivation and validation cohorts. The model was externally validated in National Institute of Neurological Disorders and Stroke trial patients with a C-statistic of 0.68. CONCLUSIONS-: The GWTG-Stroke sICH risk "GRASPS" score provides clinicians with a validated method to determine the risk of sICH in patients treated with intravenous tissue-type plasminogen activator within 3 hours of stroke symptom onset.

Original languageEnglish (US)
Pages (from-to)2293-2299
Number of pages7
JournalStroke
Volume43
Issue number9
DOIs
StatePublished - Sep 2012

Fingerprint

Intracranial Hemorrhages
Tissue Plasminogen Activator
Stroke
National Institute of Neurological Disorders and Stroke
Guidelines
National Institutes of Health (U.S.)
Calibration
Blood Glucose
Logistic Models
Blood Pressure
Hypertension

Keywords

  • acute ischemic stroke
  • intravenous tPA
  • risk score
  • symptomatic intracranial hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. / Menon, Bijoy K.; Saver, Jeffrey L.; Prabhakaran, Shyam; Reeves, Mathew; Liang, Li; Olson, Daiwai M.; Peterson, Eric D.; Hernandez, Adrian F.; Fonarow, Gregg C.; Schwamm, Lee H.; Smith, Eric E.

In: Stroke, Vol. 43, No. 9, 09.2012, p. 2293-2299.

Research output: Contribution to journalArticle

Menon, BK, Saver, JL, Prabhakaran, S, Reeves, M, Liang, L, Olson, DM, Peterson, ED, Hernandez, AF, Fonarow, GC, Schwamm, LH & Smith, EE 2012, 'Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator', Stroke, vol. 43, no. 9, pp. 2293-2299. https://doi.org/10.1161/STROKEAHA.112.660415
Menon, Bijoy K. ; Saver, Jeffrey L. ; Prabhakaran, Shyam ; Reeves, Mathew ; Liang, Li ; Olson, Daiwai M. ; Peterson, Eric D. ; Hernandez, Adrian F. ; Fonarow, Gregg C. ; Schwamm, Lee H. ; Smith, Eric E. / Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. In: Stroke. 2012 ; Vol. 43, No. 9. pp. 2293-2299.
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AU - Menon, Bijoy K.

AU - Saver, Jeffrey L.

AU - Prabhakaran, Shyam

AU - Reeves, Mathew

AU - Liang, Li

AU - Olson, Daiwai M.

AU - Peterson, Eric D.

AU - Hernandez, Adrian F.

AU - Fonarow, Gregg C.

AU - Schwamm, Lee H.

AU - Smith, Eric E.

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N2 - BACKGROUND AND PURPOSE-: There are few validated models for prediction of risk of symptomatic intracranial hemorrhage (sICH) after intravenous tissue-type plasminogen activator treatment for ischemic stroke. We used data from Get With The Guidelines-Stroke (GWTG-Stroke) to derive and validate a prediction tool for determining sICH risk. METHODS-: The population consisted of 10 242 patients from 988 hospitals who received intravenous tissue-type plasminogen activator within 3 hours of symptom onset from January 2009 to June 2010. This sample was randomly divided into derivation (70%) and validation (30%) cohorts. Multivariable logistic regression identified predictors of intravenous tissue-type plasminogen activator-related sICH in the derivation sample; model β coefficients were used to assign point scores for prediction. RESULTS-: sICH within 36 hours was noted in 496 patients (4.8%). Multivariable adjusted independent predictors of sICH were increasing age (17 points), higher baseline National Institutes of Health Stroke Scale (42 points), higher systolic blood pressure (21 points), higher blood glucose (8 points), Asian race (9 points), and male sex (4 points). The C-statistic was 0.71 in the derivation sample and 0.70 in the independent internal validation sample. Plots of observed versus predicted sICH showed good model calibration in the derivation and validation cohorts. The model was externally validated in National Institute of Neurological Disorders and Stroke trial patients with a C-statistic of 0.68. CONCLUSIONS-: The GWTG-Stroke sICH risk "GRASPS" score provides clinicians with a validated method to determine the risk of sICH in patients treated with intravenous tissue-type plasminogen activator within 3 hours of stroke symptom onset.

AB - BACKGROUND AND PURPOSE-: There are few validated models for prediction of risk of symptomatic intracranial hemorrhage (sICH) after intravenous tissue-type plasminogen activator treatment for ischemic stroke. We used data from Get With The Guidelines-Stroke (GWTG-Stroke) to derive and validate a prediction tool for determining sICH risk. METHODS-: The population consisted of 10 242 patients from 988 hospitals who received intravenous tissue-type plasminogen activator within 3 hours of symptom onset from January 2009 to June 2010. This sample was randomly divided into derivation (70%) and validation (30%) cohorts. Multivariable logistic regression identified predictors of intravenous tissue-type plasminogen activator-related sICH in the derivation sample; model β coefficients were used to assign point scores for prediction. RESULTS-: sICH within 36 hours was noted in 496 patients (4.8%). Multivariable adjusted independent predictors of sICH were increasing age (17 points), higher baseline National Institutes of Health Stroke Scale (42 points), higher systolic blood pressure (21 points), higher blood glucose (8 points), Asian race (9 points), and male sex (4 points). The C-statistic was 0.71 in the derivation sample and 0.70 in the independent internal validation sample. Plots of observed versus predicted sICH showed good model calibration in the derivation and validation cohorts. The model was externally validated in National Institute of Neurological Disorders and Stroke trial patients with a C-statistic of 0.68. CONCLUSIONS-: The GWTG-Stroke sICH risk "GRASPS" score provides clinicians with a validated method to determine the risk of sICH in patients treated with intravenous tissue-type plasminogen activator within 3 hours of stroke symptom onset.

KW - acute ischemic stroke

KW - intravenous tPA

KW - risk score

KW - symptomatic intracranial hemorrhage

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