Advances in the mechanism of hemorrhagic transformation after intravenous thrombolysis in ischemic stroke
Hemorrhagic transformation(HT)is spontaneous cerebral hemorrhage in the infarct area caused by ischemia-reperfusion and secondary hemorrhage caused by taking corresponding treatment measures such as tissue plasminogen activator(tPA),etc.The inci-dence of HT after intravenous thrombolysis is related to multiple factors such as NIHSS score,hypertension,hyperglycemia,atrial fibrilla-tion and the use of anticoagulant drugs in patients with acute ischemic stroke(AIS).Neuroinflammatory response is considered to be an important component in mediating ischemia-reperfusion injury and is closely related to the occurrence and development of HT.tPA-APC pathway plays a key role in ischemia-reperfusion injury.Activated protein C(APC)mainly acts on protease-activated receptor(PAR-1)and reduces tPA dissolution by inhibiting the NF-KB-mediatedmatrix metalloproteinase 9(MMP-9)pathway.Reviewing the mechanisms and preventive measures of hemorrhagic transformation after intravenous thrombolysis in AIS will help to clarify treatment targets,develop target-specific neuroprotective drugs,and early predict HT through biomarkers,and continuously improve ischemic risk,so as to continu-ously improve the clinical safety of intravenous thrombolysis for ischemic stroke and improve patient prognosis.
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