Hemorrhagic transformation in acute ischemic stroke - The MAST-E study

Background and Purpose-Hemorrhagic transformation (HT) is the most critical complication of thrombolytics in clinical trials in acute stroke. The aim of this study was to determine the rates and the predictors of HT in the Mu lticenter Acute Stroke Trial-Europe (MAST-E) study. Methods-We performed a post hoc analysis of MAST-E data designed to assess the safety and efficacy of streptokinase administered intravenously within 6 hours of stroke onset. HT included all intracerebral hemorrhages and symp tomatic hemorrhages (SHT) associated with clinical worsening. The predictor s of PIT and SHT were determined using multivariate modeling. Results-Among the 310 patients included, 159 patients had HT and 37 SHT (97 and 33 in the streptokinase group and 62 and 4 in the placebo group, respe ctively). Patients with SPIT had significantly more atrial fibrillation, di abetes mellitus, no heparin use, streptokinase treatment, and early CT sign s. In the multivariate analysis, HT was predicted by early CT signs and str eptokinase treatment. SPIT was predicted by diabetes mellitus, early CT sig ns, streptokinase treatment, and the interaction between streptokinase trea tment and decreased level of consciousness, Among the streptokinase-treated patients, the same predictors remained. Conclusions-The relative risks of HT after streptokinase were in the same r ange in MAST-E as in other streptokinase and tPA trials. Early CT signs wer e strong predictors of both HT and SHT, stressing that these patients are a t high risk of bleeding. In our study, the predictors of HT and SHT were si milar to those of tPA trials in acute stroke.