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Article
The iScore Predicts Efficacy and Risk of Bleeding in the NINDS rtPA stroke trial
Journal of Stroke and Cerebrovascular Disease (2012)
  • Gustavo Saposnik
Abstract

Background and Purpose: The iScore is a validated tool to estimate outcomes after an acute ischemic stroke. A previous study showed the iScore can predict clinical response and risk of intracerebral hemorrhage (ICH) after tPA. Methods: We applied the iScore (www.sorcan.ca/iscore) to participants in the NINDS tPA stroke trials to evaluate its ability to estimate clinical response and risk of ICH after thrombolysis. Based on results from our previous study, patients were stratified a priori according to the iScore in <200 and>≥200. The main outcome measure was ICH. Secondary outcomes included: favorable composite outcome (defined as a modified Rankin scale of 0 or 1, NIHSS≤1, Barthel index≥ 95or Glasgow outcome scale <1 at 3>months) and functional outcomes. Results: Of the 624 patients enrolled in the trial, the iScore was calculated in all 624 patients. There were 507 (81%) patients with an iScore <200 and 117>(19%) with an iScore > 200. An iScore ≥200 was associated with greater risk of symptomatic ICH in the tPA compared to the placebo group (15.4% vs.3.9%; p=0.04). Similar finding were observed for ICH of any type (30.8% vs.11.5%; p=0.014) with higher ICH fatality (69.2% vs.23.8%; p<0.001). Despite a higher favorable composite outcome of tPA among participants with iScore<200 (58.7% vs41.9%;p<0.001), there was no benefit among participants with an iScore≥200 (15.4% vs 13.4%; p=0.77). Conclusion: In patients receiving tPA in the NINDS trials, the iScore estimated the clinical response and risk of hemorrhagic complications. Further prospective studies are necessary before changing practice.

Keywords
  • iScore,
  • risk score,
  • stroke,
  • outcomes,
  • thrombolysis,
  • tPA,
  • hemorrhage
Publication Date
October, 2012
Citation Information
Gustavo Saposnik. "The iScore Predicts Efficacy and Risk of Bleeding in the NINDS rtPA stroke trial" Journal of Stroke and Cerebrovascular Disease (2012)
Available at: http://works.bepress.com/gustavo_saposnik/36/