085 Standardising quoted post-thrombolysis bleeding complication rates using the Heidelberg Bleeding Classification

Published Date: 21st November 2016

Publication Authors: Hill AM

Introduction
Intracerebral haemorrhage is one of the most feared complications of delivering thrombolysis therapy. Variable complication rates are quoted for symptomatic haemorrhage post-thrombolysis, reflecting difficulty establishing whether the extent of haemorrhage, or the original infarction was responsible for the eventual outcome. National datasets such as the Stroke Sentinel National Audit Project (SSNAP) are dependent upon consistent data from many sites where ‘symptomatic haemorrhage’ may be subjectively interpreted and inter-rater variability is high. We aimed to pilot whether using the Heidelberg Bleeding Classification in routine post-thrombolysis CT reporting would be a appropriate method.

Method
Post-thrombolysis scans at our UK hyperacute stroke centre were retrospectively classified using the anatomical haemorrhage description described in the Heidelberg Bleeding Classification. The CT reviewer was blinded to the neurological outcome of the individual. These results were then combined with the patients’ SSNAP record, and comparison to NIHSS scores at admission, 24 hrs post-discharge and 7-day mortality

Results
322 consecutive thrombolysis patients were identified between January 2015 and May 2016. 107 patients did not have a recorded 24-hr NIHSS score and were excluded from the study. 1 patient with a stroke and type 2 respiratory failure died before repeat scanning could be achieved. Some evidence of bleeding was identified on 22/237 (9.3%) images. 77% of patients had improved NIHSS at 24 hrs. 12 patients had petechial haemorrhages with similar rates of improvement and significant improvements in NIHSS at 24 hrs. 1 patient had a small haematoma, and 4 large haematomas with mass effect: these patients fared poorly. 3 had subdural, subarachnoid, or ICH remote from the infarction: these fared worse than with no bleeding but outcome was less predictable.

Conclusion
A robust classification of post-tPA haemorrhage will aid understanding of complication rates. The anatomical description in the Heidelberg classification is simple and quick to administer and combined with SSNAP data provides a richer descriptor of findings and outcome. In our local study, petechial haemorrhages showed significant improvements in NIHSS: these may be inconsequent or possibly even a positive feature of recanalisation. National registries should look to standardise reporting of bleeding complications following thrombolytics; the Heidelberg classification is a suitable standard. Further study with larger, national datasets could help to understand predictors of poor outcome and incidence of true complications.

 

Hill A. (2022). 085 Standardising quoted post-thrombolysis bleeding complication rates using the Heidelberg Bleeding Classification. International Journal of Stroke. 11 (Suppl 4), 47

 

 

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