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Coagulopathy Often Untreated in Brain Hemorrhage Patients

40 percent of patients experience ongoing bleeding after diagnosis

WEDNESDAY, Aug. 11 (HealthDay News) -- In many patients with symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic therapy for acute stroke, coagulopathy goes untreated, and often, patients experience continued bleeding after diagnosis, according to research published in the August issue of the Archives of Neurology.

In a retrospective analysis, Joshua N. Goldstein, M.D., of the Massachusetts General Hospital in Boston, and colleagues evaluated data from the Get With the Guidelines-Stroke database, which were prospectively collected between April 1, 2003, and Dec. 31, 2007. The researchers identified 2,362 patients with acute ischemic stroke during this time frame.

The investigators found that sICH occurred in 19 of 311 patients with acute ischemic stroke who received intravenous tissue plasminogen activator and two of the 72 patients who underwent intra-arterial thrombolysis. They also found that in-hospital mortality was significantly higher in patients with sICH than in those without the complication (75 versus 16.9 percent), with independent predictors of in-hospital mortality including sICH (odds ratio [OR], 32.6), increasing National Institutes of Health Stroke Scale score (OR, 1.2), older age (OR, 1.3), and intra-arterial thrombolysis (OR, 2.9). In addition, 11 of 20 patients received treatment for coagulopathy, and treatment was not linked to outcome. Continued bleeding occurred in 40 percent of patients with available follow-up scans.

"The finding that continued bleeding occurs after diagnosis suggests an opportunity for intervention; it remains to be determined whether any currently available therapy can meet this need or whether novel treatments should be developed," the authors write. "As a next step, a multicenter registry of current management of thrombolysis-associated ICH and outcomes appears warranted."

One author disclosed financial ties to CSL Behring and Genentech Inc.

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