Objective  To explore the influencing factors of adverse bleeding reactions caused by alteplase in patients with acute cerebral infarction and to construct a risk prediction model.

Methods The clinical data of patients with acute cerebral infarction treated with alteplase in Lishui Central Hospital from January to October 2024 were retrospectively analyzed, and the patients were divided into bleeding group and non-bleeding group. Multivariate Logistic regression analysis was used to determine the independent risk factors for alteplase-induced adverse bleeding reactions, and a prediction model was constructed. The receiver characteristic curve (ROC) and area under the curve (AUC) calibration curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve were used to evaluate the model performance.

Results  A total of 99 patients were included, with 23 in the bleeding group and 76 in the non-bleeding group, The bleeding incidence was 23.23%. Multivariate logistic regression analysis showed that age ≥ 65 years [OR=4.894, 95%CI (1.067, 22.442)], concurrent hypertension [OR=1.489, 95%CI (1.489, 4.046)], longer time window for thrombolysis [OR=1.195, 95%CI (1.064, 1.341)], and thrombocytopenia [OR=2.284, 95%CI (1.571, 3.321)] were independent risk factors for alteplase-induced bleeding adverse reactions (P<0.05). After establishing the prediction model, the AUC of the training set and the validation set models were 0.93 and 0.89, respectively. The Hosmer-Lemeshow goodness-of-fit test showd that the fitted probability value was basically consistent with the actual probability value. The decision curve showed that when the threshold probability of the training set was 0.02-1.0 and the threshold probability of the validation set was 0.1-1.0, the model could produce better clinical benefits.

Conclusion  Alteplase used for thrombolysis in patients with acute cerebral infarction has a certain risk of bleeding adverse reactions. Patients with age≥65 years old, concurrent hypertension, long thrombolysis time window, and thrombocytopenia are more likely to cause bleeding. Clinically, it is necessary to take careful medication into comprehensive consideration.

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