Current Neurovascular Research   Thanin Lokeskrawee 1 , Sombat Muengtaweepongsa 2,* , Jayanton Patumanond 3 , Somsak Tiamkao 4 , Thanoot Thamangraksat 5 , Phanyarat Phankhian 6 , Polchai Pleumpanupat 7 , Paworamon Sribussara 7 , Teeraparp Kitjavijit 7 , Anake Supap 8 , Weerawan Rattanaphibool 8 and Jariya Prisiri 9 1 Department of Emergency Medicine, Lampang Hospital, Lampang, Thailand; 2 Department of Internal Medicine, Division of Neurology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 3 Department of Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 4 Department of Internal Medicine, Division of Neurology, North Eastern Research Group, Khon Kaen University, Khon Kaen, Thailand; 5 Department of Internal Medicine, Division of Neurology, Chiang Rai Hospital, Chiang Rai, Thailand; 6 Department of Internal Medicine, Division of Neurology, Uttaradit Hospital, Uttaradit, Thailand; 7 Division of Neurology, Department of Internal Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand; 8 Department of Emergency Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand; 9 Department of Internal Medicine, Nan Hospital, Nan, Thailand Abstract: Background: Symptomatic intracranial hemorrhage (sICH) is a major complication after intravenous thrombolysis leading to severe disability and death. The incidence was higher in Asian than in western countries. Prognostic factors across ethnicities are presumably different. Studies in Asian populations are limited. Method: Clinical data from January 2008 to September 2016 in one provincial and four regional hospitals in the northern part of Thailand were retrospectively reviewed. Patients were those with acute ischemic stroke, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed. They were classified into 3 groups; no intracranial hemorrhage (no ICH), asymptomatic intracranial hemorrhage (asICH) and symptomatic intracranial hemorrhage (sICH), based on clinical and brain imaging (computed tomography or CT). Prognostic parameters were investigated using a multi-level, multivariable ordinal logistic model. Results: After exclusion of ineligible patients, the remaining 1,172 patients were classified into no ICH (n=923, 78.8%), asICH (n=154, 13.1%) and sICH (n=95, 8.1%). Independent prognostic parameters for intracranial hemorrhage were the National Institutes of Health Stroke Scale (NIHSS) >20 (OR, 3.51; 95% CI, 2.18-5.65; p<0.001), NIHSS >10 (OR, 2.02; 95% CI, 1.42-2.87; p<0.001), use of nicardipine during rt-PA (OR, 1.61; 95% CI, 1.09-2.40; p=0.018), systolic blood pressure (SBP) prior to thrombolysis ≥ 140 mmHg (OR, 1.47; 95% CI, 1.06-2.04; p=0.021), and platelet count <250,000 cell/mm3 (OR, 1.45; 95% CI, 1.04-2.01; p=0.029). Conclusion: Patients with these parameters should be closely monitored. Information should be provided to the patients and their relatives. Keywords: Stroke, thrombolytic therapy, tissue plasminogen activator, intracranial hemorrhages, prognosis, risk factors. 1. INTRODUCTION In the past decades, there are some alternative strategies to treat acute ischemic stroke (AIS), but thrombolysis with *Address correspondence to this author at the Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat Univerisity, Pathum Thani 12120, Thailand; Tel: 66-869994208; E-mail: sombatm@hotmail.com intravenous recombinant tissue plasminogen activator (rt- PA) is still the standard treatment for patients who presented within 3-4.5 hours after the onsets [1]. Symptomatic intracranial hemorrhages (sICH) are the major complications after treatment that hampered widespread endorsement by clinicians. The prevalence of sICH varied from 1.9-8.9% based on different definitions [2-7]. In Thailand, only 1.95% of the patients with AIS received intravenous rt-PA [8], A R T I C L E H I S T O R Y Received: December 28, 2016 Revised: February 16, 2017 Accepted: March 03, 2017 DOI: 10.2174/1567202614666170327163905 1875-5739/17 $58.00+.00 © 2017 Bentham Science Publishers Send Orders for Reprints to reprints@benthamscience.ae Current Neurovascular Research, 2017, 14, 169-176 169 RESEARCH ARTICLE Prognostic Parameters for Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in an Asian Population