High-density lipoprotein level is associated with hemorrhage transformation after ischemic stroke treatment with intravenous thrombolysis: A systematic review and meta-analysis

  • Wei Zhang
    Department of Neurology, Shaanxi Provincial People’s Hospital, No. 256 Youyixi Road, Xi’an 710068, Shaanxi, China

    Xi’an Medical University, No. 74 Hanguangbei Road, Xi’an 710068, Shaanxi, China
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  • Wei Li
    Corresponding author.
    Department of Neurology, Shaanxi Provincial People’s Hospital, No. 256 Youyixi Road, Xi’an 710068, Shaanxi, China
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  • Ruiping Tian
    Department of Neurology, Shaanxi Provincial People’s Hospital, No. 256 Youyixi Road, Xi’an 710068, Shaanxi, China

    Xi’an Medical University, No. 74 Hanguangbei Road, Xi’an 710068, Shaanxi, China
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  • Lei Cao
    Department of Neurology, Shaanxi Provincial People’s Hospital, No. 256 Youyixi Road, Xi’an 710068, Shaanxi, China

    Xi’an Medical University, No. 74 Hanguangbei Road, Xi’an 710068, Shaanxi, China
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      • HDL was associated with HT after intravenous thrombolysis, and it could be considered a predictor of the risk of HT.
      • This finding suggests that HDL may have an important impact on the occurrence of HT.
      • This is the first meta-analysis that estimate the association between HDL and the risk of HT post-IV tPA.
      • Inflammation changes composition and function of circulating HDL, may resulting in a decreased ability to promote cholesterol efflux from macrophages.



      Treatment of acute ischemic stroke (AIS) with intravenous tissue-type plasminogen activator is effective in few patients when administered within 4.5 h after symptom onset. Hemorrhage transformation (HT) is a major cause of poor prognosis of AIS patients post intravenous rt-PA. Several studies report that high-density lipoprotein (HDL) cholesterol is associated with increased risk of HT. However, various studies report inconsistent results.


      The aim of the present study was to explore the association between HDL and HT after treatment of AIS patients by intravenous thrombolysis.


      A literature search for studies on the relationship between HDL and HT after treatment of AIS by intravenous thrombolysis published before, 28 Mar 2022, was conducted in PubMed, EMBASE, Cochrane, Web of Science, CNKI, CPVIP, Wan fang and SINOMED databases. Fixed effects model was used to estimate the mean differences (MDs) at 95% confidence interval (CI). Heterogeneity was assessed by Cochran’s Q statistic and quantified by the I2 statistic. Analysis of included studies was carried out using Review Manager 5.4 and the publication bias was evaluated using Stata 16.0.


      A total of 445 studies were screened and 9 studies met the inclusion criteria and were included in this meta-analysis (n = 3673). The results showed that AIS patients with HT had significantly higher HDL concentrations compared with the AIS patients without HT (pooled mean difference, 0.05; 95% confidence interval (CI), 0.01–0.09; P = 0.008).


      The findings showed that HDL was associated with HT after treatment of AIS by intravenous thrombolysis, implying that is a potential predictor of the risk of HT.


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