Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation

Ju Hun Lee, Kwang Yeol Park, Joon Hyun Shin, Jae Kwan Cha, Hahn Young Kim, Jee Hyun Kwon, Hyung Geun Oh, Kyung Bok Lee, Dong Eog Kim, Sang Won Ha, Kyung Hee Cho, Sung Il Sohn, Mi Sun Oh, Kyung Ho Yu, Byung Chul Lee, Sun U. Kwon

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)


Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16-35.14), previous hemorrhagic stroke (OR 10.67, 1.77-64.25), and low platelet count (OR per 104 increase 0.87, 0.79-0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.

Original languageEnglish
Pages (from-to)193-200
Number of pages8
JournalEuropean Neurology
Issue number4
Publication statusPublished - 2010 Oct
Externally publishedYes


  • Acute ischemic stroke
  • Anticoagulation
  • Atrial fibrillation
  • Hemorrhagic transformation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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