What is putting ischemic stroke patients at risk of having a hemorrhagic stroke?

This study investigated what risk factors may cause ischemic stroke patients to have different types of hemorrhagic stroke after treatment.

A stroke is a disturbance of blood flow to a part of the brain. Strokes can be caused by either a ruptured blood vessel (hemorrhagic stroke), or a blood clot that blocks blood flow (ischemic stroke).

Treatment for ischemic stroke includes an injection of tissue-type plasminogen activator (tPA), which breaks up blood clots. However, because this drug inhibits the ability of blood to clot, it temporarily increases the risk of internal bleeding if a brain blood vessel were to rupture, therefore resulting in a hemorrhagic stroke.

The blood vessel can rupture where the ischemic stroke occurred (local hemorrhage) or in a different brain area (remote hemorrhage). 

This study investigated what risk factors are associated with hemorrhages after an ischemic stroke, what the mortality rate is within the first 3 months, and the degree of disability (functional outcome) among survivors.   

A total of 43,494 ischemic stroke patients that received tPA were included in the study. Out of these patients, 970 (2.2%) had a remote hemorrhage, 2325 (5.3%) had a local hemorrhage, and 438 (1%) had both local and remote hemorrhages.

The study found that if patients were older and had a previous stroke, they were more likely to develop a remote brain hemorrhage after taking tPA for an ischemic stroke.

On the other hand, atrial fibrillation (abnormal heart rhythm), hyperdense cerebral artery sign (a head scan that shows a blood clot in a main brain artery typically used to diagnose ischemic stroke), and elevated blood glucose were associated with local hemorrhages.

More patients who had a remote hemorrhage (34%) were functionally independent (ability to perform everyday tasks without assistance) at 3 months, compared to only 24% of those with a local hemorrhage. Also, 34% of remote hemorrhage patients died within 3-months, compared to 39% of local hemorrhage patients. 

The study concluded that the occurrence of a remote brain hemorrhage after an ischemic stroke was associated with previous blood vessel damage such as a previous stroke, compared with local hemorrhages, which were associated with abnormal heart rhythm, large-blood vessel blockage and high blood sugar. 

Patients with remote hemorrhage had a lower mortality and better functional outcome but this was largely due to less severe ischemic strokes. 

If you or someone you know is at high risk of having a stroke, ask a doctor whether there are ways you can help reduce the chances of having a brain hemorrhage after ischemic stroke treatment.