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.