SITS-ICH Score: Explanation and Clinical Context The SITS-ICH Score is a validated clinical tool designed to predict the risk of symptomatic intracranial hemorrhage (sICH) following intravenous thrombolysis with alteplase in patients with acute ischemic stroke. Developed from the SITS-MOST registry, it uses baseline demographic and clinical variables to provide an individualized estimate of hemorrhagic risk.
The score incorporates six parameters: age >70 years, systolic blood pressure >170 mmHg, blood glucose >9 mmol/L (~162 mg/dL), baseline NIHSS (0–10 = 0, 11–20 = 1, >21 = 2), history of anticoagulant use, and weight <70 kg. The total score ranges from 0 to 6, with higher scores indicating greater risk of sICH.
Patients with low scores (0–2) have a low risk (~1–2%) of sICH, moderate scores (3–4) indicate moderate risk (~5–10%), and high scores (5–6) are associated with high risk (>10%). This tool assists clinicians in risk stratification prior to thrombolysis, informing monitoring intensity and shared decision-making regarding treatment.
Reference:
1. Mazya M, et al. Predicting symptomatic intracerebral hemorrhage after thrombolysis: SITS-ICH risk score. Stroke. 2012;43(6):1524–1531.
2. Wahlgren N, et al. SITS-MOST: Safe Implementation of Thrombolysis in Stroke Monitoring Study. Lancet. 2007;369:275–282.