Glycosylated Hemoglobin A1 Predicts Risk for Symptomatic Hemorrhage After Thrombolysis for Acute Stroke

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Symptomatic intracerebral hemorrhage after intravenous treatment with tissue-type plasminogen activator (tPA) in acute ischemic stroke is a potentially devastating event with a high mortality rate.

Many factors are thought to increase the risk of hemorrhage, including damage to the microvasculature. Hemoglobin A1 (HbA1c) is a marker for long-term elevated glucose level and is used for monitoring diabetic vascular damage. In this retrospective analysis, Rocco et al investigated the predictive value of HbA1c for symptomatic intracerebral hemorrhage and clinical outcome in patients treated with intravenous tPA for acute ischemic stroke. The authors reviewed >1000 patients treated with tPA from 1998 to 2011 at the Neurological Department in Heidelberg, Germany. Any hemorrhage occurred in 222 patients (19.9%); 43 of those had symptomatic intracerebral hemorrhage (3.9%) per Safe Implementation of Treatments in Stroke definition and 95 (8.5%) per National Institute of Neurological Disorders and Stroke definition. In multivariate analysis, HbA1c was highly significantly associated with any hemorrhage and symptomatic intracerebral hemorrhage with a cut-off value of 6.5%, regardless of the definition used. By contrast, blood glucose at baseline was not statistically significantly associated with any type of hemorrhage. In multivariate analysis, age, National Institutes of Health Stroke Scale score on admission, and HbA1c were predictors of dependent outcome (modified Rankin Scale, 3–5). HbA1c is an important predictor of symptomatic intracerebral hemorrhage after thrombolysis for acute ischemic stroke. These results suggest that hemorrhage after thrombolysis may be a consequence of long-term vascular injury rather than of acute hyperglycemia. Patients should not be excluded from …