Background: Symptomatic intracranial hemorrhage (sICH) is a major complication after
intravenous thrombolysis leading to severe disability and death. The incidence was higher in Asian
than in western countries. Prognostic factors across ethnicities are presumably different. Studies in
Asian populations are limited.
Method: Clinical data from January 2008 to September 2016 in one provincial and four regional
hospitals in the northern part of Thailand were retrospectively reviewed. Patients were those with
acute ischemic stroke, to whom recombinant tissue plasminogen activator (rt-PA) had been
prescribed. They were classified into 3 groups; no intracranial hemorrhage (no ICH), asymptomatic
intracranial hemorrhage (asICH) and symptomatic intracranial hemorrhage (sICH), based on
clinical and brain imaging (computed tomography or CT). Prognostic parameters were investigated
using a multi-level, multivariable ordinal logistic model.
Results: After exclusion of ineligible patients, the remaining 1,172 patients were classified into no
ICH (n=923, 78.8%), asICH (n=154, 13.1%) and sICH (n=95, 8.1%). Independent prognostic
parameters for intracranial hemorrhage were the National Institutes of Health Stroke Scale (NIHSS)
>20 (OR, 3.51; 95% CI, 2.18-5.65; p<0.001), NIHSS >10 (OR, 2.02; 95% CI, 1.42-2.87; p<0.001),
use of nicardipine during rt-PA (OR, 1.61; 95% CI, 1.09-2.40; p=0.018), systolic blood pressure
(SBP) prior to thrombolysis ≥ 140 mmHg (OR, 1.47; 95% CI, 1.06-2.04; p=0.021), and platelet
count <250,000 cell/mm3 (OR, 1.45; 95% CI, 1.04-2.01; p=0.029).
Conclusion: Patients with these parameters should be closely monitored. Information should be
provided to the patients and their relatives.