Incidence, timing and predictors of intracerebral haemorrhage after intravenous thrombolysis in patients with minor ischaemic stroke

Background Haemorrhagic risk after intravenous thrombolysis (IVT) has been explored in eligible patients with acute ischaemic stroke, but not in minor ischaemic stroke (MIS). The study aimed to investigate the incidence, timing and risk factors for intracranial haemorrhage (ICH) in patients with MIS administered intravenous prourokinase. Materials and methods Patients with MIS who received IVT within 4.5 hours of symptom onset were included in this post-hoc exploratory analysis of the Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke (PUMICE) trial. ICH was defined as any imaging-identified haemorrhage after prourokinase treatment. The time to ICH was defined as the time from prourokinase administration bolus to documented head CT order time with the first evidence of new haemorrhage. Factors associated with ICH were determined by logistic regression models. A meta-analysis of the incidence of symptomatic ICH (sICH) after thrombolysis in patients with MIS was conducted. Results Of the 726 patients with MIS enrolled in PUMICE with prourokinase administration, the median age was 65.9 years, and 33.8% were women. 21 (2.9%) developed ICHs after IVT with a delayed timing fashion, of which 5 were sICH (0.7%). The median time to ICH was 24.1 hours. Elevated neutrophil to lymphocyte ratio and impaired renal function were identified as independent risk factors for increased risk of ICH in patients with MIS after thrombolysis. The pooled incidence of sICH was 1.2%. Conclusions The incidence of sICH and ICH after intravenous prourokinase in patients with MIS is low. Future studies are warranted to identify risk factors and patterns of ICH after other thrombolytic agents’ administration.