Intracranial hemorrhage (ICH) is a devastating neurologic event. One form of ICH is hemorrhagic transformation of ischemic stroke (HT), which typically occurs in the days immediately following the infarct. HT often results in neurologic deficits, long-term disability, or death. It is unknown whether all types of ICH share common risk factors. The ability to predict who is at highest risk for HT and ICH is important to clinicians, particularly when considering treatment with anticoagulation, a common occurrence given the increasing frequency of patients with atrial fibrillation, blood clots, and mechanical valves. Anticoagulation itself likely increases risk of HT, making this group a potentially high-risk patient population. Until recently, no clinical tool existed to accurately estimate risk. Using a retrospective cohort of inpatients with acute stroke with an indication for anticoagulation, we found that age, infarct volume, and renal impairment are important predictors of HT. We created a Hemorrhage Risk Stratification (HeRS) score using these factors, specifically for the inpatient population, to allow physicians to quickly and accurately predict their patient’s individual risk of hemorrhagic conversion. This is useful not only to inform the clinical team and the patient of the expected risk, but also to guide treatment decisions. The HeRS score has been prospectively validated in a unique prospectively recruited inpatient cohort.

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