Hemorrhagic Conversion (CVA/Stroke) and Occupational Therapy

Definition of Hemorrhagic Conversion in Occupational Therapy

An ischemic infarct converting into a hemorrhagic lesion.

Prevalence and Cause

  • Occurs in 10% of patients.
  • More common in large infarcts.
  • Ranges from minor bleeding to major hemorrhage.
  • Thrombi can migrate, lyse, and re-perfuse into an ischemic area, leading to small hemorrhages because of poor integrity in the damaged capillaries and small blood vessels. Damaged areas then combine and form a hemorrhage.
    • In other words, a few hours after an area of brain tissue has died, it loses its ability to retain blood inside of the arteries, increasing the risk that a large hemorrhage will occur if blood flow were to be returned.


  • In patients with large infracts, anticoagulation therapy is not used due to the risk of hemorrhagic conversion.
  • Approximately 6% of all stroke cases treated with intravenous tPA experience a hemorrhagic conversion, hence the current practice of administration within the window after the onset of symptoms.cc

Occupational Therapy Intervention

  • Educate patients and family about stroke symptoms and activating EMS due to the benefits of anticoagulants (tPA) within the golden hour/window.
  • Monitor patients during treatments for symptoms of neurological changes that may be due to hemorrhagic conversion.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.