Jailard A, for the Multicenter Stroke Trial – Europe Group [Univ. Hosp. Grenoble, France]
Hemorrhagic Transformation in Acute Ischemic Stroke : The Mast-E Study
Stroke 30 : 1326-1332, 1999
The risk factors for hemorrhagic transformation [HT], following the administration of streptokinase after stroke, have not been well studied. The occurrence and the late predictors of cerebral HT in both strptokinase and placebo group was investigated in a post hoc analysis of data from the double-blind, controlled, Multicenter Acute Stroke Trial Europe [MAST-E] Study.
Three hundred and ten patients received either 1,500,000 units of streptokinase [n=156] or placebo [n=154], administered intravenously, within 6 hours of the onset of stroke symptoms. Mortality and severe disability were assessed at 6 months followup, safety was evaluated at 10 days, and asymptomatic HT and symptomatic HT [SHT] were evaluated by CT within 5 days.
HT was seen in 96 patients [61%] in the streptokinase group [37 with SHT] and in 61 patients [31%] in the placebo group [ 4 with SHT]. Patients with SHT were significantly more likely to have diabetes, atrial fibrillation, no heparin use, streptokinase treatment, and early CT signs.
According to the study, early CT signs, were strong predictors of HT and SHT in stroke patients, particularly in the streptokinase treated cases. Patients with decreased level of consciousness were more likely to get SHT.