Evaluation of the Predictors of Hemorrhagic Transformation After intravenous Thrombolysis in Hyperacute Ischemic Stroke in a Tertiary Neurology Hospital of Bangladesh

Authors

  • Mohammad Yousuf Ali National Institute of Neuroscience Hospital
  • Aminur Rahman Professor, Department of Neurology, Sir Salimullah Medical College, Dhaka- 1100, Bangladesh https://orcid.org/0000-0001-9261-7734
  • Bikash Chandra Paul Registrar, Dept. of medicine, Jessore Medical college, Jessore, Bangladesh
  • Sarah Ahmed Tamannat Lecturer, Department of Community Medicine & Public Health, MCWH, Dhaka, Bangladesh
  • Kazi Ismat Zakiau Medical Officer, Sreenagar Health Complex, Munshiganj, Bangladesh

Keywords:

Acute ischemic stroke, intravenous thrombolysis, hemorrhagic transformation, NIHSS, risk factors

Abstract

Background: Hemorrhagic transformation (HT) is a major complication after intravenous thrombolysis (IVT) in hyperacute ischemic stroke and may worsen early outcomes. Objective: To evaluate baseline clinical, hemodynamic, and laboratory predictors of HT among hyperacute ischemic stroke patients treated with IVT in a stroke unit of a referral neuroscience hospital. Methods: This observational study was conducted in the Stroke Unit of the National Institute of Neurosciences & Hospital (NINS&H), Dhaka, Bangladesh, from March 2024 to March 2025. A total of 100 patients aged 18–80 years who received IV rt-PA within 4.5 hours of symptom onset were included. HT was categorized as hemorrhagic infarction (HI1/HI2) or parenchymal hematoma (PH1/PH2) on follow-up imaging. Data were analyzed with IBM SPSS Statistics version 27. Group comparisons were performed between patients with and without HT, and univariate logistic regression was used to estimate odds ratios (ORs). Results: HT occurred in 12/100 (12.0%) patients (HI1 2.0%, HI2 8.0%, PH1 1.0%, PH2 1.0%). Patients with HT were older, more frequently smokers, had higher baseline and repeat NIHSS, higher admission blood pressures, and higher baseline glucose and HbA1c. In univariate models, significant predictors included age >65 years (OR 10.04), smoking (OR 11.30), lower GCS score (OR 4.72 per 1 unit decrease), higher baseline NIHSS (OR 1.87 per point), higher SBP (OR 2.02 per 10 mmHg), higher baseline glucose (OR 1.40 per mmol/L), higher HbA1c (OR 2.80 per 1%), hypertension (OR 9.17), diabetes (OR 7.26), dyslipidemia (OR 27.72), prior stroke (OR 11.54), and higher ASPECTS score (OR 4.22 per point). Conclusion: HT after IVT was associated with older age, smoking, greater stroke severity, elevated blood pressure, dysglycemia, and vascular comorbidities. Routinely available baseline variables may help stratify HT risk and guide monitoring intensity after thrombolysis.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 221-222.

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Author Biography

Aminur Rahman, Professor, Department of Neurology, Sir Salimullah Medical College, Dhaka- 1100, Bangladesh

Prof. Dr. Aminur Rahman is now working as Professor and Head, Department of Neurology, Sir Salimullah Medical College, Dhaka, Bangladesh. He graduated from Sylhet M.A.G. Osmani Medical College under the University of Chittagong, Bangladesh, in 1998. He has completed his MD in Neurology from the University of Dhaka and his FCPS in Internal Medicine from the Bangladesh College of Physicians and Surgeons (BCPS), Dhaka. He has been awarded the FRCP (Edinburgh), UK. He has also been honored as a Fellow of the ACP (FACP). He achieved his fellowship in Interventional Neuroradiology (FINR) from the University Hospital of Zurich, Switzerland, and also trained at Ramathibodi Hospital, Mahidol University, Thailand. Recently, in 2024, he has been awarded an Honorary Fellowship by the Indian College of Physicians (FICP).

He is now working as Editor-in-Chief of the Bangladesh Journal of Medicine (BJM), Joint Editor-in-Chief of the Journal of the Bangladesh College of Physicians and Surgeons (JBCPS), and Editor of the Bangladesh Journal of Neurosciences (BJN). He is also serving as an International Editorial Board Member of the Journal of the Indian Medical Association (JIMA) and the Journal of Neurology and Neurorehabilitation Research (JNNR), UK. He has published more than 77 research papers in reputed journals, both national and international. He is also the author of four textbooks: “Basics of EEG—1st ed. (2024)”; “Short Cases in Clinical Neurology—3rd ed. (2024)”; “Neuroimaging in Clinical Practice—2nd ed. (2022)”; and “Fundamentals in Clinical Neurology—2nd ed. (2023),” which were published in India and Bangladesh.

He is a medical scientist and received research grants for research projects six times from the Ministry of Science and Technology, Bangladesh. He is a member of the Institutional Review Board (IRB) of Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh. He attended different national and international seminars and symposiums in medicine and neurology and interventional neuroradiology in Bangladesh, Switzerland, Thailand, Malaysia, USA, Canada, India, UAE. Australia as faculty and resource persons.

 

He is a regular examiner of the different universities of Bangladesh as a clinical examiner of undergraduate students of MBBS under Dhaka University (DU) of Bangladesh, FCPS (Medicine) of Bangladesh College of Physicians and Surgeons (BCPS) and MD Neurology under Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, and MRCP (PACES), UK. 

I am Prof. Dr. Aminur Rahman, now working as a professor and head of the Department of Neurology at Sir Salimullah Medical College, Dhaka, Bangladesh. I graduated from Sylhet M.A.G. Osmani Medical College at the University of Chittagong, Bangladesh, in 1998. I have completed my MD in Neurology from the University of Dhaka and my FCPS in Internal Medicine from the Bangladesh College of Physicians and Surgeons (BCPS), Dhaka. I have been awarded the FRCP (Edinburgh), UK. I have also been honored as a Fellow of the ACP (FACP). He achieved his fellowship in Interventional Neuroradiology (FINR) from the University Hospital of Zurich, Switzerland, and also trained at Ramathibodi Hospital, Mahidol University, Thailand. Recently, in 2024, he was awarded an Honorary Fellowship by the Indian College of Physicians (FICP).

I am now working as Deputy Executive Editor of the Bangladesh Journal of Medicine (BJM), Joint Editor in Chief Journal of the Bangladesh College of Physicians and Surgeons (JBCPS), and Editor of the Bangladesh Journal of Neurosciences (BJN). He is also serving as an International Editorial Board Member of the Journal of the Indian Medical Association (JIMA) and the Journal of Neurology and Neurorehabilitation Research (JNNR), UK. He has published more than 65 research papers in reputed journals, both national and international. He is also the author of four textbooks: “Basics of EEG—1st ed. (2024)”; “Short Cases in Clinical Neurology—3rd ed. (2024)”; “Neuroimaging in Clinical Practice—2nd ed. (2022)”; and “Fundamentals in Clinical Neurology—2nded. (2023),” which are published in India and Bangladesh.

I am a medical scientist and received research grants for research projects six times from the Ministry of Science and Technology, Bangladesh. He is a member of the Institutional Review Board (IRB) of Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh. I have attended different national and international seminars and symposiums in medicine, neurology, and interventional neuroradiology in Bangladesh, Switzerland, Thailand, Malaysia, USA, Canada, India, and the UAE. Australia as faculty and resource person.

I am a regular examiner of the different universities of Bangladesh as a clinical examiner of undergraduate students of MBBS under Dhaka University (DU) of Bangladesh, FCPS (Medicine) of Bangladesh College of Physicians and Surgeons (BCPS), and MD Neurology under Bangladesh Medical University (BMU), Bangladesh,, and MRCP (PACES), UK.

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Published

2026-07-26

How to Cite

Ali, M. Y., Rahman, A., Paul, B. C., Tamannat, S. A., & Zakiau, K. I. (2026). Evaluation of the Predictors of Hemorrhagic Transformation After intravenous Thrombolysis in Hyperacute Ischemic Stroke in a Tertiary Neurology Hospital of Bangladesh. Bangladesh Journal of Medicine, 37(20), 221-222. https://doi.org/10.3329/bjm.v37i20.89256

Issue

Vol. 37 No. 2 (Supplement, May 2026)

Section

Scientific Presentation

How to Cite

Ali, M. Y., Rahman, A., Paul, B. C., Tamannat, S. A., & Zakiau, K. I. (2026). Evaluation of the Predictors of Hemorrhagic Transformation After intravenous Thrombolysis in Hyperacute Ischemic Stroke in a Tertiary Neurology Hospital of Bangladesh. Bangladesh Journal of Medicine, 37(20), 221-222. https://doi.org/10.3329/bjm.v37i20.89256