Mazya et al reported a score for predicting symptomatic intracerebral hemorrhage (sICH) in a patient with ischemic stroke treated with the thrombolytic agent alteplase. The authors are from the Safe Implementation of Treatments in Stroke (SITS) registry and data from the SITS Monitoring Study (MOST).
Patient selection: ischemia stroke treated with alteplase
Outcome: symptomatic intracerebral hemorrhage (type 2 parenchymal hemorrhage with NIHSS deterioration >= 4 points or death)
Parameters at baseline:
(1) age in years
(2) blood glucose in mg/dL
(3) systolic blood pressure in mm Hg
(4) body weight in kilograms
(5) history of hypertension
(6) time from onset to treatment in minutes
(7) NIHSS score
(8) antiplatelet therapy
|
Parameter |
Finding |
Points |
|
age in years |
< 72 years of age |
0 |
|
|
>= 72 years of age |
1 |
|
blood glucose |
< 180 mg/dL |
0 |
|
|
>= 180 mg/dL |
2 |
|
systolic blood pressure |
< 146 mm Hg |
0 |
|
|
>= 146 mm Hg |
1 |
|
body weight |
< 95 kg |
0 |
|
|
>= 95 kg |
1 |
|
history of hypertension |
no |
0 |
|
|
yes |
1 |
|
time to treatment |
< 180 minutes |
0 |
|
|
>= 180 minutes |
1 |
|
NIHSS |
<= 6 |
0 |
|
|
7 to 12 |
1 |
|
|
>= 13 |
2 |
|
antiplatelet therapy |
none |
0 |
|
|
aspirin alone |
2 |
|
|
aspirin with clopidogrel |
3 |
|
|
other |
0 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the overall risk for symptomatic ICH.
|
Total Score |
Risk Group |
Percent ICH |
|
0 to 2 |
low |
0.4% |
|
3 to 5 |
average |
1.5% |
|
6 to 8 |
moderate |
3.6% |
|
9 to 12 |
high |
9.2% |
Specialty: Hematology Oncology, Neurology, Clinical Laboratory, Pharmacology, clinical
