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    Risk for intracranial hemorrhage after tissue plasminogen activator treatment for acute myocardial infarction. Participants in the National Registry of Myocardial Infarction 2

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    Authors
    Gurwitz, Jerry H.
    Gore, Joel M.
    Goldberg, Robert J.
    Barron, Hal V.
    Breen, Timothy
    Rundle, Amy Chen
    Sloan, Michael A.
    French, William J.
    Rogers, William J.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Fallon Healthcare System
    University of Massachusetts Medical School
    Department of Medicine, Division of Cardiovascular Medicine
    Document Type
    Journal Article
    Publication Date
    1998-10-24
    Keywords
    Age Factors
    Aged
    Cerebral Hemorrhage
    Cerebrovascular Disorders
    Female
    Humans
    Logistic Models
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Myocardial Infarction
    Risk Factors
    *Thrombolytic Therapy
    Tissue Plasminogen Activator
    Tomography, X-Ray Computed
    Life Sciences
    Medicine and Health Sciences
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    Link to Full Text
    https://doi.org/10.7326/0003-4819-129-8-199810150-00002
    Abstract
    BACKGROUND: The efficacy of thrombolytic therapy in reducing mortality from acute myocardial infarction has been unequivocally shown. However, thrombolysis is related to bleeding complications, including intracranial hemorrhage. OBJECTIVE: To determine the frequency of and risk factors for intracranial hemorrhage after recombinant tissue-type plasminogen activator (tPA) given for acute myocardial infarction in patients receiving usual care. DESIGN: Large national registry of patients who have had acute myocardial infarction. SETTING: 1484 U.S. hospitals. PATIENTS: 71073 patients who had had acute myocardial infarction from 1 June 1994 to 30 September 1996, received tPA as the initial reperfusion strategy, and did not receive a second dose of any thrombolytic agent. MEASUREMENT: Intracranial hemorrhage confirmed by computed tomography or magnetic resonance imaging. RESULTS: 673 patients (0.95%) were reported to have had intracranial hemorrhage during hospitalization for acute myocardial infarction; 625 patients (0.88%) had the event confirmed by computed tomography or magnetic resonance imaging. Of the 625 patients with confirmed intracranial hemorrhage, 331 (53%) died during hospitalization. An additional 158 patients (25.3%) who survived to hospital discharge had residual neurologic deficit. In multivariable models for the main effects of candidate risk factors, older age, female sex, black ethnicity, systolic blood pressure of 140 mm Hg or more, diastolic blood pressure of 100 mm Hg or more, history of stroke, tPA dose more than 1.5 mg/kg, and lower body weight were significantly associated with intracranial hemorrhage. CONCLUSIONS: Intracranial hemorrhage is a rare but serious complication of tPA in patients with acute myocardial infarction. Appropriate drug dosing may reduce the risk for this complication. Other therapies, such as primary coronary angioplasty, may be preferable in patients with acute myocardial infarction who have a history of stroke.
    Source

    Ann Intern Med. 1998 Oct 15;129(8):597-604.

    DOI
    10.7326/0003-4819-129-8-199810150-00002
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/38895
    PubMed ID
    9786806
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    Link to article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.7326/0003-4819-129-8-199810150-00002
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