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.