Abstract WP24: Symptomatic hemorrhage after thrombolysis: results from the Alteplase compared to Tenecteplase in patients with acute ischemic stroke trial
Bibliographic record
Abstract
Introduction: Because of the risk of infarcted tissue leading to symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis for acute ischemic stroke, patients are monitored for at least 24 hours in a critical care setting. We aim to assess incidence and risk factors of sICH following thrombolysis for acute ischemic stroke. We hypothesize that the incidence of sICH is higher in patients with older age, longer symptom onset-to-needle (OTN), greater stroke severity, and lower baseline ASPECTS score. Methods: Adults ≥18 years with acute ischemic stroke were randomized into the AcT trial to receive either intravenous TNK or tPA between December 2019 to January 2022 in 22 stroke centres in Canada. Patient demographics, stroke details, hemorrhagic complications (ICH, parenchymal hematoma, hemorrhagic infarct), and duration of hospital stay were collected. ANOVA and Chi-square tests compared demographic and clinical details across three groups: sICH, asymptomatic ICH (aICH), and no ICH (nICH). We developed logistic regression models to predict sICH and any ICH accounting for age, sex, pre-treatment NIHSS, OTN, baseline ASPECTS, and thrombolytic agent. Preliminary Results: A total of 1556 participants were identified (sICH=51, aICH=261, nICH=1244). Mean age (72.02±14.2 years; p=0.11) and sex (48% female, p=0.13) were comparable between the groups. Mean pre-treatment NIHSS was highest in the sICH group (sICH 14.41±8.5, aICH 13.48±7.0, nICH 1055±6.6; p<0.001). Mean OTN was comparable across groups (sICH 141.90±62.6 min, aICH 142.65±65.1 min, nICH 144.46±69.5 min; p=0.90). Median ASPECTS was lower in the sICH group (sICH 8.00±1.7, aICH 9.00±1.6, nICH 9.00±1.4; p<0.001). There were higher odds of sICH with lower ASPECTS score (OR 0.81, 95% CI [0.66, 1], p=0.054). The risk of any intracranial hemorrhage was lower with higher ASPECTS score (OR 0.82, 95% CI [0.74, 0.91], p<0.001) and higher with worse NIHSS (OR 1.04, 95% CI [1.01, 1.06], p<0.01). Age, sex, OTN, and type of thrombolysis had no association with intracranial hemorrhage (Figure 1). Conclusions: The risk of intracranial bleeding is greater when the infarct is more established and in patients with higher pre-treatment neurological deficit. Future analyses will seek to identify predictors of time to symptomatic bleeding, and to understand whether 24-hour ICU monitoring is needed for every recipient of thrombolysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".