Brass et al reported a model for predicting the risk of intracranial hemorrhage following thrombolytic therapy for an acute myocardial infarction (AMI). This can help to identify a patient who may require more aggressive management. The authors are from Yale University, Qualidigm, Meyers Primary Care Institute and the University of Massachusetts.
Patient selection: >= 65 years of age and thrombolytic therapy for AMI
Outcome: intracerebral hemorrhage
Parameters:
(1) age in years
(2) race
(3) sex
(4) history of stroke
(5) systolic blood pressure in mm Hg
(6) body weight
(7) INR or prothrombin time (PT), with only 1 performed
(8) thrombolytic agent
Parameter
Finding
Points
age in years
< 75 years
0
>= 75 years
1
race
Black
1
other
0
sex
male
0
female
1
history of stroke
no
0
yes
1
systolic blood pressure
< 160 mm Hg
0
>= 160 mm Hg
1
body weight
female and <= 65 kg
1
female and > 65 kg
0
male and <= 80 kg
1
male and > 80 kg
0
INR or PT
INR > 4 or PT > 24 seconds
1
INR <= 4 or PT <= 24 seconds
0
thrombolytic agent
tissue plasminogen activator (TPA)
1
other
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of an intracranial hemorrhage.
Score
Percent with Intracerebral Hemorrhage
0 or 1
0.7%
2
1%
3
1.6%
4
2.5%
5 to 8
4.1%
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