Abstract: Objective To analyze the influencing factors of hemorrhagic transformation (HT) after thrombolysis with alteplase (rt-PA) in the elderly patients with acute cerebral infarction (ACI). Methods A total of 80 elderly patients with ACI who received intravenous thrombolysis with rt-PA from July 2019 to July 2021 in our hospital were enrolled. The patients were divided into HT group (n=16) and non-HT group (n=64) according to whether the patients presented with HT. The clinical data of the two groups were compared. Multivariate Logistic regression was used to analyze the independent influencing factors of HT after thrombolysis in the elderly patients with ACI. The receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of the related factors to predict HT after thrombolysis in the elderly patients with ACI, and nomogram prediction model was constructed and its efficiency was evaluated. Results The history of atrial fibrillation (AF), National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, mean platelet volume (MPV) and platelet distribution width (PDW) were the independent risk factors of HT in the elderly patients with ACI after thrombolysis, while Alberta stroke program early CT (ASPECT) score was an independent protective factor (P<0.05). The area under the ROC curve (AUC), sensitivity and specificity of the combination of the influencing factors in predicting HT were significantly higher than those of each factor alone (P<0.05). The nomograph model showed a high degree of discrimination, accuracy, and effectiveness. Conclusions The history of AF, NIHSS score before thrombolysis, ASPECT score, MPV and PDW are closely related to the occurrence of HT after thrombolysis in the elderly patients with ACI.

Key words: acute cerebral infarction, ateplase, hemorrhagic transformation, risk factor