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Alteplase is the only approved treatment for acute ischemic stroke (AIS) and results in an improvement in a third of treated patients. Most studies evaluated the post-alteplase haemorrhagic transformation of brain infarction as a homogeneous entity but we evaluated the predictors of each subtype of haemorrhagic transformation of brain infarction. Our trial included 616 AIS alteplase-treated patients. We evaluated the ability of different risk factors, clinical presentation, and imaging features to predict different haemorrhagic transformation (HT) subtypes. HT was seen in 152 patients (24.7%), higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction, in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 (odds ratio [OR], 11.04; 95% CI, 9.81 to 12.70; P-value\u2009&gt;\u20090.001) and type2 (OR, 11.89; 95% CI, 9.79 to 14.44; P-value\u2009&gt;\u20090.001), while older age was also an independent predictor of parenchymal hematoma type1 (OR, 1.312; 95% CI, 1.245 to 1.912; P-value 0.02). In AIS patients treated with alteplase in Egypt and Saudi Arabia, higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction; in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 and 2, while older age was also an independent predictor of parenchymal hematoma type1. Trial registration: (clinicaltrials.gov NCT06337175), retrospectively registered on 29\/03\/2024.<\/jats:p>","DOI":"10.1038\/s41598-024-76189-0","type":"journal-article","created":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T13:51:55Z","timestamp":1732974715000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A multicenter trial on the predictors of different subtypes of hemorrhagic infarction after thrombolysis"],"prefix":"10.1038","volume":"14","author":[{"given":"Mohamed G.","family":"Zeinhom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherihan Rezk","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed","family":"Kohail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Islam Fathallah Mohamed","family":"Kamel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ALshimaa Mahfouz","family":"Abdelrahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar M.","family":"AL-Nozha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Almoataz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek Youssif Omar","family":"Youssif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed Ali","family":"Daabis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossam Mohamed","family":"Refat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Ahmed Mohamed Kamal","family":"Ebied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elbassiouny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Zaki Omar","family":"Akl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashfaq","family":"Shuaib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Ismaiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa Ibrahem Desouky Mostafa","family":"Ibrahem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Fouad Elsayed","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,30]]},"reference":[{"key":"76189_CR1","doi-asserted-by":"publisher","unstructured":"Zeinhom, M. 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