The THRIVE Score Predicts Symptomatic Intracerebral Hemorrhage after Intravenous tPA Administration in SITS-MOST

Abstract

Background

The Totaled Health Risks in Vascular Events (THRIVE) score is a clinical prediction score that predicts ischemic stroke outcomes in patients receiving intravenous tissue plasminogen activator, endovascular stroke treatment, or no acute therapy. We have previously found an association between THRIVE and risk of post-tissue plasminogen activator symptomatic intracranial hemorrhage in the National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator trial and risk of radiographic hemorrhage in Virtual International Stroke Trials Archive.

Aims

The study aims to validate the relationship between THRIVE and symptomatic intracranial hemorrhage among tissue plasminogen activator-treated patients in the large Safe Implementation of Thrombolysis in Stroke – Monitoring Study (SITS-MOST).

Methods

This is a retrospective analysis of the prospective SITS-MOST to examine the relationship between THRIVE and symptomatic intracranial hemorrhage after tissue plasminogen activator treatment. Symptomatic intracranial hemorrhage after tissue plasminogen activator was defined according to each of three standard definitions: the NINDS, European Cooperative Acute Stroke Study (ECASS), and Safe Implementation of Thrombolysis in Stroke (SITS) criteria. Multivariable logistic regression was used to confirm the relationship of THRIVE and individual THRIVE components with the risk of symptomatic intracranial hemorrhage and to examine the relationship of THRIVE, symptomatic intracranial hemorrhage, and functional outcome.

Results

The odds ratio for symptomatic intracranial hemorrhage at each increased level of THRIVE score is 1·34 (95% CI 1·27 to 1·41, P < 0·001) for symptomatic intracranial hemorrhage by NINDS criteria, 1·36 (95% CI 1·27 to 1·46, P < 0·001) for symptomatic intracranial hemorrhage by ECASS criteria, and 1·21 (95% CI 1·09 to 1·36, P < 0·001) for symptomatic intracranial hemorrhage by SITS criteria. In receiver-operator characteristics analysis, the C-statistic for THRIVE prediction of symptomatic intracranial hemorrhage was 0·65 (95% CI 0·62 to 0·67) for symptomatic intracranial hemorrhage by NINDS criteria, 0·66 (95% CI 0·63 to 0·69) for symptomatic intracranial hemorrhage by ECASS criteria, and 0·61 (95% CI 0·56 to 0·66) for symptomatic intracranial hemorrhage by SITS criteria. Each component of the THRIVE score predicts the risk of symptomatic intracranial hemorrhage, with independent impact of each component in multivariable analysis.

Conclusions

The THRIVE score predicts the risk of symptomatic intracranial hemorrhage after intravenous tissue plasminogen activator administration. This external validation of the relationship between THRIVE and symptomatic intracranial hemorrhage in a prospective study further strengthens the role of the THRIVE score in the prediction of poststroke outcomes.

Keywords

acute stroke therapy cerebral infarction intracerebral hemorrhage ischemic stroke rtPA treatment

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References

Flint

Cullen

Faigeles

Rao

. Predicting long-term outcome after endovascular stroke treatment: The totaled health risks in vascular events score. AJNR Am J Neuroradiol 2010; 31: 1192–6. doi: 10.3174/ajnr.A2050.

Flint

Kamel

Rao

Cullen

Faigeles

Smith

. Validation of the Totaled Heath Risks in Vascular Events (THRIVE) score for outcome prediction in endovascular stroke treatment. Int J Stroke 2014; 9: 32–9.

Kamel

Patel

Rao

. The THRIVE score predicts ischemic stroke outcomes independent of thrombolytic therapy in the NINDS tPA trial. J Stroke Cerebrovasc Dis 2013; 22: 1111–6.

Flint

Faigeles

Cullen

. THRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA. Stroke 2013; 44: 3365–9. doi: 10.1161/STROKEAHA.113.002794.

Flint

Xiang

Gupta

. THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial. Stroke 2013; 44: 3370–5. doi: 10.1161/ STROKEAHA.113.002796.

Wahlgren

Ahmed

Dávalos

. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): An observational study. Lancet 2007; 369: 275–82. doi: 10.1016/S0140-6736(07)60149-4.

Ali

Bath

Brady

. Development, expansion, and use of a stroke clinical trials resource for novel exploratory analyses. Int J Stroke 2012; 7: 133–8. doi: 10.1111/j.1747-4949.2011.00735.x.

The NINDS tPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–7. doi: 10.1056/ NEJM199512143332401.

The NINDS tPA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 1997; 28: 2109–18.

10.

Hacke

Kaste

Fieschi

. Randomised double-blind placebocontrolled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998; 352: 1245–51.

11.

Lou

Safdar

Mehdiratta

. The HAT score: A simple grading scale for predicting hemorrhage after thrombolysis. Neurology 2008; 71: 1417–23. doi: 10.1212/01.wnl.0000330297.58334.dd.

12.

Mazya

Egido

Ford

. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: Safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke 2012; 43: 1524–31. doi: 10.1161/STROKEAHA.111.644815.

13.

Menon

Saver

Prabhakaran

. Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Stroke 2012; 43: 2293–9. doi: 10.1161/STROKEAHA.112.660415.

14.

Cucchiara

Tanne

Levine

Demchuk

Kasner

. A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke. J Stroke Cerebrovasc Dis 2008; 17: 331–3. doi: 10.1016/j.jstrokecerebrovasdis.2008.03.012.

15.

Saposnik

Fang

Kapral

. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke 2012; 43: 1315–22. doi: 10.1161/STROKEAHA.111.646265.

16.

Strbian

Engelter

Michel

. Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN score. Ann Neurol 2012; 71: 634–41. doi: 10.1002/ana.23546.

17.

Saposnik

Guzik

Reeves

Ovbiagele

Johnston

. Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100. Neurology 2012; 43: 1315–22. doi: 10.1212/WNL.0b013e31827b1ace.

18.

Sung

S-F

Chen

SC-C

Lin

H-J

Chen

Y-W

Tseng

M-C

Chen

C-H

. Comparison of risk-scoring systems in predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis. Stroke 2013; 44: 1561–6. doi: 10.1161/STROKEAHA.111.000651.

19.

Cucchiara

Kasner

Tanne

. Validation assessment of risk scores to predict postthrombolysis intracerebral haemorrhage. Int J Stroke 2011; 6: 109–11. doi: 10.1111/j.1747-4949.2010.00556.x.

20.

Meretoja

Strbian

Mustanoja

Tatlisumak

Lindsberg

Kaste

. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 2012; 79: 306–13. doi: 10.1212/WNL.0b013e31825d6011.

21.

Meretoja

Weir

Ugalde

. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 2013; 81: 1071–6. doi: 10.1212/WNL.0b013e3182a4a4d2.