Interview with Professor Wu Bo: Thoughts on bleeding transformation after intravenous thrombolysis CSA & TISC 2021

Acute ischemic stroke is one of the important reasons that threaten human health at present, and it has the characteristics of extremely high disability rate and fatality rate
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Intravenous thrombolytic therapy within 4.
5 hours of onset can allow patients without contraindications to obtain recent vascular recanalization and reduce the probability of re-stroke
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However, there are still some patients with transformation of cerebral hemorrhage, leading to a poor prognosis
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At the 7th Annual Conference of the Chinese Stroke Society and the Tiantan International Cerebrovascular Disease Conference (CSA & TISC 2021), Yimaitong was fortunate to interview Professor Wu Bo on the topic of hemorrhage transformation after intravenous thrombolysis.
The articles are organized As follows
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The author of this article: Yimaitong Tiantan will report the report group Yimaitong compiled reports, please do not reprint without authorization
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Professor Wu Bo, Postdoctoral Fellow, West China Hospital, Sichuan University, Professor of Neurology, West China Hospital, Sichuan University, and Associate Director, Doctoral Supervisor, Harvard Medical School, Visiting Scholar, World Stroke Organization, Youth Committee, Chinese Medical Association Neurology Branch, 7th Youth Committee, Chinese Medical Association Neurology Member and Secretary of the Cerebrovascular Disease Group of the Academic Branch, Standing Member of the Young and Middle-aged Expert Committee of the Stroke Screening and Prevention Engineering Committee of the National Health and Health Commission, Deputy Chairman of the Youth Committee of the Sichuan Neurology Special Committee, Sichuan Neurology Special Committee, Cerebrovascular Disease The thirteenth batch of academic and technical leaders in Sichuan Province, the deputy leader of the academic group, published more than 30 papers in Lancet Neurology, Neurology, Stroke, JNNP, JCBFM and other journals, and undertook 5 projects from the National Natural Science Foundation of Medicine: Intravenous Dissolution In the treatment of thrombus, clinicians are most worried about the problem of cerebral hemorrhage after thrombolysis
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Would you please briefly introduce why there is a risk of hemorrhagic transformation after intravenous thrombolysis? Professor Wu Bo, for patients undergoing intravenous thrombolysis, the biggest problem they face is the transformation of bleeding after thrombolysis
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Several large randomized controlled trials have proved that the probability of bleeding after the use of alteplase (rt-PA) drugs is about 6%; and fatal intracranial hemorrhage is about 3%
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However, taking preventive measures clinically can reduce the occurrence of such incidents: First, pay attention to the management of patient blood pressure after thrombolysis, and control the blood pressure within 180/100mmHg
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If the patient's blood pressure is too high, the risk of hemorrhage transformation after thrombolysis will also increase, which is a problem on the one hand
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Secondly, if the patient has leukoaraiosis, a large number of cerebral microbleeds and other predisposing factors, it will also increase the risk of bleeding
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Of course, there are some reasons that can also lead to an increase in hemorrhagic transformation.
For example, among the subtypes of stroke, the rate of hemorrhagic transformation in cardiogenic stroke is higher than that of large atherosclerosis and small artery disease
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In general, bleeding cannot be completely avoided, because the medication itself has the risk of hemorrhage transformation; secondly, even if the patient does not use the medicine after the infarction, there will be the risk of hemorrhage transformation
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Therefore, preventable factors should be controlled clinically.
One is to strictly control blood pressure, and the other is to conduct imaging evaluation before thrombolysis, and fully consider other risk factors for hemorrhage transformation in patients, and control them in advance
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Yimaitong: In clinical intravenous thrombolytic therapy, how to prevent the occurrence of hemorrhage transformation? Professor Wu Bo wants to prevent the occurrence of hemorrhage transformation after thrombolysis.
The first point is that patients should be strictly screened in clinical treatment, and only patients who meet the indications for thrombolysis can undergo thrombolysis
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The second point is that close observation and strict management should be strengthened after thrombolysis
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For example, for thrombolytic blood pressure monitoring, blood pressure should be monitored every 15 minutes in the first two hours of the early stage, and blood pressure monitoring must be strengthened in the later stage to ensure that the patient's blood pressure is controlled within the range of 180/100mmHg
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In addition, special attention should be paid to the medication.
The first 10% of the dose of the drug is administered by intravenous bolus injection, and the subsequent 90% of the dose is continuously pumped for no less than one hour
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If the medication is used too fast and irregularly, it will also increase the patient's risk of bleeding
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Yimaitong: If bleeding occurs after thrombolysis, what should I do? Hemorrhage transformation after thrombolysis by Professor Wu Bo can be divided into different situations.
The first type has hemorrhagic transformation, but the patient does not experience aggravation of clinical symptoms.
For these patients, do not worry too much, just need to closely monitor whether there is any point after thrombolysis.
Or focal bleeding
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If the patient's physical signs have not worsened or worsened through clinical evaluation, this situation only needs to be closely observed
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The second situation is that the patient has experienced deterioration of clinical symptoms, or increased consciousness, paralysis, headache, nausea, and vomiting.
This is called symptomatic intracranial hemorrhage transformation or symptomatic cerebral hemorrhage
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The management and control of such patients should be handled according to the severity of the disease
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In severe cases, neurosurgical intervention is required to evaluate the patient for signs of hematoma removal
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If there are indications for surgery, proceed to surgical treatment
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If the patient’s intracranial hemorrhage has not reached the standard for surgical management, and the medication in the acute phase has not been completed, the first is to stop the drug, and then the prothrombin complex, plasma, etc.
can be infused for anti-therapeutic treatment
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In general, the transformation that occurs after thrombolysis is mainly handled according to whether the patient's clinical symptoms are aggravated.
If the patient is asymptomatic, close monitoring is sufficient; if the symptoms are severe, comprehensive management should be carried out according to the two principles of internal medicine and surgery.

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