Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasminogen activator: a systematic review and meta-analysis

OBJECTIVE: To identify risk factors for haemorrhagic transformation in Chinese patients with acute ischaemic stroke treated with recombinant tissue plasminogen activator. METHODS: We searched electronic databases including PubMed, EMBASE, CNKI and WanFang Data for studies reporting risk factors of haemorrhagic transformation after intravenous thrombolysis. Pooled OR, weighted mean difference (WMD) and 95% CI were estimated. Meta-analysis was performed by using Stata V.14.0 software. RESULTS: A total of 14 studies were included. The results indicated that older age (WMD=3.46, 95% CI 2.26 to 4.66, I(2)=47), atrial fibrillation (OR 2.66, 95% CI 1.85 to 3.81, I(2)=28), previous stroke (OR 1.68, 95% CI 1.08 to 2.60, I(2)=14), previous antiplatelet treatment (OR 1.67, 95% CI 1.17 to 2.38, I(2)=0), higher National Institute of Health stroke scale scores (OR 1.10, 95% CI 1. 05 to 1.15, I(2)=36), systolic (WMD=4.75, 95% CI 2.50 to 7.00, I(2)=42) or diastolic (WMD=2.67, 95% CI 1.08 to 4.26, I(2)=35) pressure, and serum glucose level (WMD=1.44, 95% CI 0.62 to 2.26, I(2)=66) were associated with increased risk of post-thrombolysis haemorrhagic transformation. CONCLUSION: The current meta-analysis identified eight risk factors for post-thrombolysis haemorrhagic transformation in Chinese patients with acute ischaemic stroke. Given the risk of bias, these results should be explained with caution and do not justify withholding intravenous thrombolysis.