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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(07): 390-396
DOI: 10.1590/0004-282X20200008
Article

Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts’ opinion

Preditores de transformação hemorrágica após acidente vascular cerebral isquêmico agudo a partir da opinião de especialistas
João Brainer Clares de ANDRADE 
1   Universidade Federal de São Paulo, Vascular Neurology Department, São Paulo SP, Brazil.
2   Columbia University, Doris and Stanley Tananbaum Stroke Center, New York City, USA.
,
Jay Preston MOHR
2   Columbia University, Doris and Stanley Tananbaum Stroke Center, New York City, USA.
,
Fabricio Oliveira LIMA 
3   Hospital Geral de Fortaleza, Vascular Neurology Department, Fortaleza CE, Brazil.
,
Levi Coelho Maia BARROS
4   Universidade Estadual do Ceará, Medicina School, Fortaleza CE, Brazil.
,
Camila Rodrigues NEPOMUCENO
4   Universidade Estadual do Ceará, Medicina School, Fortaleza CE, Brazil.
,
Leonardo Barreira PORTELA
4   Universidade Estadual do Ceará, Medicina School, Fortaleza CE, Brazil.
,
Gisele Sampaio SILVA
1   Universidade Federal de São Paulo, Vascular Neurology Department, São Paulo SP, Brazil.
5   Hospital Israelita Albert Einstein, Department of Neurology, São Paulo SP, Brazil.
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ABSTRACT

Background: Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. Objective: To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. Methods: We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. Results: The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. Conclusion: Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT.

RESUMO

Introdução: A transformação hemorrágica (TH) é uma complicação comum após a isquemia cerebral e pode estar associada a desfechos desfavoráveis. Alguns fatores de risco para TH têm sido identificados, mas ainda há controvérsias. Objetivo: Descrever os fatores de risco para TH mais frequentemente reportados por um painel de especialistas consultados para esse projeto. Métodos: Enviamos um questionário padronizado por e-mail para 45 especialistas em Neurologia Vascular no período de 2014 a 2018. Vinte dos 45 especialistas responderam ao convite. Preditores citados por três ou mais especialistas foram incluídos em uma tabela e classificados pela frequência em que foram reportados. Uma revisão de literatura foi realizada em busca de escores preditivos de TH publicados anteriormente, comparando-os com as respostas recebidas. Resultados: Os 20 especialistas citaram 23 diferentes fatores de risco para TH. Os fatores mais frequentemente citados foram, pela ordem, volume da isquemia, uso prévio de medicação antitrombótica, gravidade neurológica, idade, hiperglicemia na apresentação, hipertensão na admissão e cardioembolismo. A maioria das variáveis também foi incluída em escores preditivos de TH já publicados, mas sem a mesma frequência e com divergências entre os especialistas consultados. Conclusão: Embora muitos estudos tenham avaliado a TH em pacientes com isquemia cerebral, os fatores de risco já publicados não foram uniformes na concordância com aqueles reportados pelos neurologistas vasculares consultados. Esses achados podem ser úteis para elaborar um escore que possa ser testado para aperfeiçoar a predição de transformação hemorrágica.

Keywords:

acute ischemic stroke - hemorrhagic transformation - neurological complication

Palavras-chave:

acidente vascular cerebral isquêmico agudo - transformação hemorrágica - complicação neurológica

Support:

This study was partly financed by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.




Publication History

Received: 16 December 2019

Accepted: 10 January 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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