What are risk factors of hemorrhagic complications from thrombolytic therapy?

Updated: Aug 04, 2021
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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The most feared complication of fibrinolysis is intracranial hemorrhage (ICH), but serious hemorrhagic complications can occur from bleeding at any site in the body. Risk factors for hemorrhagic complications include the following:

  • Increasing age
  • Lower body weight
  • Elevated pulse pressure
  • Uncontrolled hypertension
  • Recent stroke or surgery
  • Presence of a bleeding diathesis
  • Severe congestive heart failure

In a study that used data from the Get With The Guidelines (GWTG)-Stroke program (N=54,334) to evaluate differences in risk-adjusted bleeding rates and mortality in White (n=40,411), Black (n=8243), Hispanic (n=4257), and Asian (n=1523) patients receiving IV tPA for acute ischemic stroke (AIS), Mehta et al found that overall adjusted hemorrhagic complication rates after tPA were higher in Black and Asian patients than in White patients. [67]

In this study, overall adjusted bleeding complications in Hispanics were similar to those of Whites. [67] Increased risk of overall bleeding in Asians was related to higher risk of adjusted symptomatic ICH (sICH); the increased risk in Blacks was related to higher risk of other bleeding. No significant race-related difference was noted in risk of serious or life-threatening bleeding or in overall mortality or death in patients with sICH or any hemorrhagic complications. Research is needed to evaluate whether lower doses of tPA, as used in many Asian countries, could improve the safety while maintaining the efficacy of tPA therapy in Asians in the United States with AIS.

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