Predictors of hemorrhagic transformation in symptomatic recurrent acute cerebral ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator

Background Hemorrhagic transformation (HT) is a challenging complication of thrombolytic therapy that can lead to increased morbidity and mortality in recurrent ischemic stroke. Aim The study aimed to identify predictors of HT in recurrent symptomatic acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. Patients and methods Forty-three patients with recurrent symptomatic AIS were recruited, and 10 of them developed HT. All patients underwent history taking and clinical examination, including Glasgow Coma Score and National Institute of Health Stroke Scale (NIHSS), Fazekas score, and modified Rankin scale, as well as radiological investigations, cardiac evaluation, and laboratory investigation [routine laboratories, neutrophil–lymphocyte ratio (NLR), C-reactive protein (CRP)-to-albumin ratio (CAR), international normalized ratio (INR), prothrombin time (PT), and fibrinogen level]. Outcome was assessed via clinical examination, NIHSS, and modified Rankin scale. Results Recurrent AIS patients with HT represented 23.2% of our sample of patients while symptomatic intracranial hemorrhage represented 13.9%. HT group had significant rates of atrial fibrillation, diabetes mellitus, hypertension, valvular heart disease, higher blood pressure, random blood sugar, Fazekas score, and NIHSS score. Most of HT patients were on anticoagulants for previous stroke. Most cases in the HT group received i.v. thrombolytic as treatment for their previous stroke. They also had increased NLR, high CAR, INR, PT, and low fibrinogen level, previous thrombolytic therapy, and low Alberta stroke program early non-contrast CT score. Conclusion HT in recurrent AIS patients receiving recombinant tissue plasminogen activator was associated with higher INR, NLR, PT, NIHSS, Fazekas score, CAR, lower fibrinogen, previous thrombolytic therapy, and low Alberta stroke program early non-contrast CT score.