Correlation between systemic bleeding during thrombolysis and intracranial hemorrhage after thrombolysis in acute ischemic stroke

Current models primarily predict outcomes before thrombolytic therapy. This study explored if systemic bleeding during thrombolysis predicts hemorrhagic transformation (HT) within 36 hours post-thrombolysis. Data from 591 acute ischemic stroke patients treated with rt-PA at Wenzhou Central Hospital (2016-2023) were prospectively collected and analyzed. The incidence of systemic bleeding was compared with the Stroke Prognostication using Age and the National Institutes of Health Stroke Scale (Span100) index, as well as the Hemorrhage After Thrombolysis (HAT) scale. Systemic bleeding occurred in 285 patients, including 92 with HT. The HT rate was significantly higher in patients with late-onset oral bleeding (35.90%) or other systemic bleeding (38.89%) than in those without (p < 0.01). Late-onset oral and systemic bleeding during thrombolysis predicted HT in anterior circulation infarction (p < 0.001) but not in posterior circulation infarction (p = 0.70). The AUC for predicting HT was 0.578 for these bleeding types, versus 0.568 for Span-100 and 0.61 for HAT. Incorporating bleeding types increased Span-100 sensitivity to 0.623 and HAT to 0.648. Late-onset oral and other systemic bleeding during thrombolysis effectively predict HT in anterior circulation infarction, enhancing the sensitivity of Span100 and HAT scales when combined.