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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPatients with symptomatic intracranial hemorrhage (sICH) have an increased risk of a poor or fatal outcome [Strbian D et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2011]. However, the direct comparison of sICH rates between different thrombolysis studies is complicated by varying definitions of sICH [Gumbinger C. et al. \u003Cem\u003EStroke\u003C\/em\u003E 2012]. This article discusses results from a study on the most accurate definition of clinically relevant hemorrhagic transformation after thrombolytic therapy for stroke with IV tissue plasminogen activator.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients with symptomatic intracranial hemorrhage (sICH) have an increased risk of a poor or fatal outcome [Strbian D et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2011]. However, the direct comparison of sICH rates between different thrombolysis studies is complicated by varying definitions of sICH [Gumbinger C. et al. \u003Cem\u003EStroke\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDefinitions include those from The National Institute of Neurological Disorders and Stroke-tPA study (NINDS) [The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1995], the second European-Australasian Acute Stroke Study (ECASS-II) [Larrue V et al. \u003Cem\u003EStroke\u003C\/em\u003E 2001], ECASS-III [Hacke W. et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2008], and The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) [Wahlgren N. et al. \u003Cem\u003ELancet\u003C\/em\u003E 2007]. Outcomes differ according to clinical, radiological, and relational criteria.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENeal M. Rao, MD, University of Colorado School of Medicine, Denver, Colorado, USA, presented results from a study on the most accurate definition of clinically relevant hemorrhagic transformation (HT) after thrombolytic therapy for stroke with IV tissue plasminogen activator (tPA).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe specific aim of this study was to determine which definition of sICH best identifies hemorrhages that alter final patient outcomes after administration of intravenous tPA in acute stroke. Analysis was based on the NINDS database, which defines sICH as any hemorrhagic transformation that is temporally related to any worsening.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMethods included an analysis of candidate definitions\u2014ie, radiological (any radiological hemorrhage or parenchymal hematoma [PH])\u2014and clinical-radiological criteria (NINDS-tPA Study, ECASS-II, and modified SITS-MOST: PH and \u22654 National Institutes of Health Stroke Scale [NIHSS] worsening).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EClinically relevant hemorrhages were defined as those that altered final outcome. A predictive model from the placebo group was derived, and outcomes with tPA were compared with predicted outcomes without tPA using a modified Rankin Scale (mRS).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe data of 312 patients who were treated with IV tPA were analyzed; 48 patients (15.4%) experienced any radiological intracranial hemorrhage (ICH). Hemorrhage frequency varied by definition (6.4%, any [PH]; 6.4%, NINDS-tPA; 5.1%, ECASS-II; and 1.9%, modified SITS-MOST). ECASS-II sICH patients had worse actual (with tPA) versus predicted (without tPA) outcomes. The mean final mRS was 5.6 (observed) versus 3.5 (predicted); death occurred in 75% (observed) versus 25.4% (predicted) of patients.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ERadiological hemorrhage patients who did not meet ECASS sICH criteria showed no difference between actual and predicted outcomes. Mean final mRS was 4.2 (observed) versus 4.0 (predicted); death occurred in 35% (observed) versus 35.1% (predicted) of patients. \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E shows actual and predicted mean mRS and mortality with and without the five definitions (any radiographic, PH, NINDS, ECASS-II, and SITS-MOST).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12716\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12716\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12716\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EOutcomes With and Without Definitions.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EStudy limitations were: only a subset of the proposed definitions of sICH was analyzed, data from the NINDS trials may not fully reflect contemporary practice, and there were a small number of patients in the NINDS dataset.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe authors concluded that the ICH classification that best identifies clinically relevant hemorrhages that alter final global disability and fatal outcome is any radiological HT that is associated with \u22654 early NIHSS worsening. They also determined that asymptomatic hemorrhages under this definition have no adverse impact on final outcomes.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/1\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzniod\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzniod\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}