Abstract
Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.
| Original language | English (US) |
|---|---|
| Journal | International Journal of Stroke |
| DOIs | |
| State | Accepted/In press - Jan 1 2017 |
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Keywords
- acute ischemic stroke
- cerebral hemorrhage
- hemorrhagic transformation
- hypoglycemic unawareness
- iatrogenic hypoglycemia
- Intensive insulin therapy
ASJC Scopus subject areas
- Neurology
Cite this
Potential link between post-acute ischemic stroke exposure to hypoglycemia and hemorrhagic transformation. / Klingbeil, Kyle D.; Koch, Sebastian; Dave, Kunjan R.
In: International Journal of Stroke, 01.01.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Potential link between post-acute ischemic stroke exposure to hypoglycemia and hemorrhagic transformation
AU - Klingbeil, Kyle D.
AU - Koch, Sebastian
AU - Dave, Kunjan R
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.
AB - Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.
KW - acute ischemic stroke
KW - cerebral hemorrhage
KW - hemorrhagic transformation
KW - hypoglycemic unawareness
KW - iatrogenic hypoglycemia
KW - Intensive insulin therapy
UR - http://www.scopus.com/inward/record.url?scp=85041897020&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041897020&partnerID=8YFLogxK
U2 - 10.1177/1747493017743797
DO - 10.1177/1747493017743797
M3 - Article
AN - SCOPUS:85041897020
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
ER -