Deans' stroke musings: Nomogram-based prediction of hemorrhagic transformation risk integrating platelet-to-white blood cell ratio in patients with acute ischemic stroke after intravenous thrombolysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, June 29, 2026

Nomogram-based prediction of hemorrhagic transformation risk integrating platelet-to-white blood cell ratio in patients with acute ischemic stroke after intravenous thrombolysis

Useless! What is the protocol that will prevent this transformation? Doesn't anyone in stroke know how to think?

Nomogram-based prediction of hemorrhagic transformation risk integrating platelet-to-white blood cell ratio in patients with acute ischemic stroke after intravenous thrombolysis

Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China

Abstract

Background:

Hemorrhagic transformation (HT) is a significant complication in acute ischemic stroke (AIS) patients after intravenous thrombolysis (IVT), frequently leading to unfavorable clinical prognoses. However, the association between the platelet-to-white blood cell ratio (PWR) and the risk of HT, along with its severity subtypes, remains largely unexplored. This study investigates the independent association between low PWR and the increased incidence and severity of HT following IVT.

Method:

This study retrospectively included AIS patients who received IVT treatment from our hospital’s stroke database. HT was identified through cranial imaging (CT/MRI) conducted within 24 h post-IVT and categorized into four subtypes based on the European Cooperative Acute Stroke Study (ECASS) criteria. The relationship between PWR and HT was examined using multivariate logistic regression. A restricted cubic spline (RCS) analysis was applied to detect the nonlinear relationship of PWR and HT. Based on variables identified via multivariate logistic regression, a nomogram-based prediction model was developed, and its performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results:

A total of 790 AIS participants were included in this study. Patients who developed HT exhibited significantly lower PWR levels compared to those without HT. The PWR levels were divided into four quartiles: Q1 (<22.0), Q2 (22.0–28.3), Q3 (28.3–36.2), and Q4 (>36.2), respectively. Multivariable logistic regression demonstrated that patients in the highest PWR quartile (Q4) had a 67% reduced risk of HT (odds ratio [OR]: 0.33; 95% confidence interval [CI]: 0.18–0.61). By integrating potential risk factors, the nomogram achieved an AUC of 0.767 (95% CI: 0.716–0.818).

Conclusion:

Lower PWR independently correlates with heightened risk and severity of HT after IVT in patients with AIS. The integration of PWR into a nomogram model provides a practical tool for stratifying HT risk, potentially guiding individualized treatment strategies.