Related Factors of Hemorrhagic Transformation After Intravenous Thrombolysis with Alteplase in Elderly Patients with Lacunar Infarction

ZHANG Jinliang; SHAO Qiuji; CHANG Kaitao

doi:10.3969/j.issn.1004-437X.2026.12.012

Abstract：Objective To investigate the related factors of hemorrhagic transformation(HT)after intravenous thrombolysis in elderly patients with lacunar infarction(LI).Methods A total of 312 elderly patients with LI who were treated in Luyi Zhenyuan Hospital from January 2023 to December 2025 were selected.After admission,they were all given alteplase intravenous thrombolysis.According to whether there was HT after thrombolysis,they were divided into the non-occurrence HT group 235 cases and occurrence HT group(77 cases).The clinical data of the two groups were statistically compared,the influencing factors of HT after thrombolysis were analyzed,and a predictive model was established,and the predictive value was analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences between the occurrence HT and non-occurrence HT groups in terms of hypertension,atrial fibrillation,drinking history,smoking index,National Institute of Health stroke scale(NIHSS)score on admission,positive urine protein,anticoagulant drugs,blood glucose concentration on admission,and blood pressure level(P＜0.05).Hypertension,positive urine protein,atrial fibrillation,no use of low molecular weight heparin,smoking index＞400,NIHSS score＞14,and high blood glucose concentration at admission were risk factors for HT after thrombolysis(P＜0.05).Logistic regression model was used to predict HT after thrombolysis with area under the curve of 0.923(95％CI:0.893-0.954).When log(P)＞5.25,the predictive sensitivity was 82.14％and the specificity was 94.12％.Conclusion Hypertension,NIHSS score,atrial fibrillation,positive urine protein,smoking index,anticoagulant drugs,and blood glucose level on admission are important influencing factors of HT after thrombolysis in elderly LI patients,and are important factors for clinical reduction of post-thrombotic thrombolysis.The bleeding risk and the development of intervention measures provide a reliable basis.