Most scores moderately predictive for hemorrhage after thrombolysis

An analysis of scores to predict symptomatic intracranial hemorrhage risk after thrombolysis found all but one were moderately predictive, with one slightly better than the others.


An analysis of scores to predict symptomatic intracranial hemorrhage risk after thrombolysis found all but one were moderately predictive, with one slightly better than the others.

Researchers used prospectively collected data from 3,012 patients at 7 stroke centers who had had ischemic stroke and received intravenous thrombolysis. With this data, they evaluated 6 scores that estimate the risk of symptomatic intracranial hemorrhage (sICH): MSS (Multicenter Stroke Survey); HAT (Hemorrhage After Thrombolysis); SEDAN (blood sugar, early infarct signs, [hyper]dense cerebral artery sign, age, NIH Stroke Scale); GRASPS (glucose at presentation, race [Asian], age, sex [male], systolic blood pressure at presentation, and severity of stroke at presentation [NIH Stroke Scale]); SITS (Safe Implementation of Thrombolysis in Stroke); and the SPAN (stroke prognostication using age and NIH Stroke Scale)-100 positive index. Only patients with available variables for all scores were included in the study. For all scores, researchers calculated the area under the receiver-operating characteristic curve (AUC-ROC) and did logistic regression analysis.

Two hundred twenty-one patients, or 7.3%, had sICH per the National Institute of Neurological Disorders and Stroke criteria, 141 (4.7%) had it per the European Cooperative Acute Stroke Study II, and 86 (2.9%) had it per Safe Implementation of Thrombolysis in Stroke criteria. The scores' performances, assessed for predicting European Cooperative Acute Stroke Study II sICH, were: MSS, AUC-ROC 0.63 (95% CI, 0.58 to 0.68); HAT, AUC-ROC 0.65 (95% CI, 0.60 to 0.70); SEDAN, AUC-ROC 0.70 (95% CI, 0.66 to 0.73); GRASPS, AUC-ROC 0.67 (95% CI, 0.62 to 0.72); SITS, AUC-ROC 0.64 (95% CI, 0.59 to 0.69); and SPAN-100 positive index, AUC-ROC 0.56 (95% CI, 0.50 to 0.61). Results were published online Jan. 28 by Stroke.

In general, SPAN-100 had poor predictive power and the other scores had moderate predictive power. SEDAN had the highest nominal predictive performance in all comparisons. The modest differences between the scores reflect that most have similar components, with differences often lying in the weighting of the components, the researchers noted.

“At the moment, we must acknowledge the limitations of post-thrombolysis hemorrhage prediction scores, and we do not have the data to support withdrawal of thrombolysis treatment, which has a proven benefit, in patients with high risk of sICH,” the researchers wrote. For now, patients at high risk of sICH would likely benefit from intensive glucose and blood pressure monitoring and heightened alertness from staff after thrombolysis is administered, they wrote.