The Significance of Various Factors Associated with Hemorrhagic Transformation in Patients Treated with Recombinant Tissue Plasminogen Activator for Acute Stroke

  • M. S. Pessin
  • S. M. Wolpert
Conference paper


Intracranial bleeding is the principal safety concern and use-limiting factor related to the application of thrombolytic agents in acute stroke. Several recent studies, using intravenously administered recombinant tissue plasminogen activator (rt-PA) for carotid and vertebrobasilar territory stroke, have documented intracranial bleeding in the form of hemorrhagic infarction (HI) and parenchymatous hematoma (PH) [2, 4, 11, 16, 19]. That intracranial bleeding is not limited to the use of thrombolytic agents in stroke patients has been amply documented in studies of patients with acute myocardial infarction treated with these agents where a small but consistent incidence has been noted in the range of approximately 0.5% (Table 1) [6, 7, 9, 10, 14, 15, 18]. The purpose of this discussion is to examine several factors presumed to be associated with intracranial bleeding in stroke patients treated with thrombolytic agents using data from the rt-PA Acute Stroke Study Group trial [4] and other recent trials [2, 8, 11, 16, 19]. A preview of this analysis suggests that many of the long and firmly held views regarding influences and effects of hemorrhagic transformation (HT) are not supported by recent information.


Acute Myocardial Infarction Acute Stroke Thrombolytic Therapy Thrombolytic Agent Embolic Stroke 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • M. S. Pessin
    • 1
  • S. M. Wolpert
    • 2
  1. 1.Department of NeurologyTufts University School of Medicine, New England Medical CenterBostonUSA
  2. 2.Department of Radiology (Division of Neuroradiology)Tufts University School of Medicine, New England Medical CenterBostonUSA

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