{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:49:26Z","timestamp":1789044566309,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This is a retrospective study conducted at the Clinical County Hospital of Craiova, Romania, providing valuable insights into hemorrhagic transformation (HT) in thrombolyzed patients with acute ischemic stroke (AIS). Hemorrhagic complications remain a significant concern after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). This study aims to analyze clinical and biological factors associated with HT following thrombolysis. Materials and Methods: A retrospective analysis was conducted on 356 patients who received rt-PA at the Clinical County Hospital of Craiova between January 2020 and December 2024. Patients were divided into three groups based on CT findings at 24 h post-thrombolysis: no HT, minimal HT, and massive HT. Baseline characteristics were analyzed, including demographics, medical history, NIHSS scores, imaging findings, and laboratory parameters. Statistical analysis was performed using ANOVA and chi-square tests, with a significance threshold of p &lt; 0.05. Results: HT occurred in 12.08% of patients (minimal HT: 8.15%, massive HT: 3.93%). Mortality was significantly higher in the massive HT group (71.43%) compared to minimal HT (41.38%) and non-HT (13.42%) (p &lt; 0.001). Lower platelet count (p = 0.003), elevated blood glucose (p = 0.004), prolonged QT interval (p = 0.004), and reduced fibrinogen levels (p = 0.005) were significantly associated with HT. Other risk factors included atrial fibrillation (p = 0.001), hypertension (p = 0.005), delayed door-to-needle time (p &lt; 0.001), diabetes mellitus (p = 0.007), dense ACM sign on CT (p = 0.003), older age (p &lt; 0.001), obesity (p = 0.001), early neurological deterioration at 2 h\/24 h (p &lt; 0.001), elevated GOT (p &lt; 0.001), elevated GPT (p = 0.002), lower LDL cholesterol (p &lt; 0.001), lower total cholesterol (p = 0.001), and lower triglycerides (p &lt; 0.001). Conclusions: Patients with HT had worse clinical outcomes, with massive HT associated with the highest mortality. Risk factors include age, nutritional status, hyperglycemia, and low platelet and fibrinogen levels, among others.<\/jats:p>","DOI":"10.3390\/medicina61040722","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T09:06:51Z","timestamp":1744621611000},"page":"722","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk Factors and Outcomes of Hemorrhagic Transformation in Acute Ischemic Stroke Following Thrombolysis: Analysis of a Single-Center Experience and Review of the Literature"],"prefix":"10.3390","volume":"61","author":[{"given":"Ileana","family":"Neac\u0103","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Sanocare Medical Center Craiova, 200061 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Elena","family":"Negroiu","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4127-0978","authenticated-orcid":false,"given":"Iulia","family":"Tudora\u0219cu","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"D\u0103noiu","sequence":"additional","affiliation":[{"name":"Sanocare Medical Center Craiova, 200061 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana Gianina","family":"Moise","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-216X","authenticated-orcid":false,"given":"Despina Manuela","family":"Toader","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-0123","authenticated-orcid":false,"given":"Suzana","family":"D\u0103noiu","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1093\/eurheartj\/ehac684","article-title":"Acute Ischaemic Stroke: Recent Advances in Reperfusion Treatment","volume":"44","author":"Widimsky","year":"2023","journal-title":"Eur. 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