Reversal of LMWH anticoagulation with protamine sulfate may allow for systemic thrombolysis in acute stroke patients who would otherwise be excluded due to anticoagulation.
May allow thrombolysis in LMWH-treated stroke; hypothesis-generating case report requiring prospective validation.
Introduction: Intravenous thrombolysis may be withheld due to current exclusion criteria even if the patient arrives at hospital in time. However, under certain circumstances, some of these contraindications could be eliminated. Case Presentation: We report a systemic thrombolysis after reversal of anticoagulation with protamine sulfate in an acute stroke patient with suspected subacute non-ST-segment elevation myocardial infarction (NSTEMI) receiving full-dose low-molecular-weight heparin (LMWH). Conclusions: Considering the fact that only less than 10% of all acute strokes are eligible for intravenous thrombolysis, in particular circumstances and weighing a risk-benefit ratio, elimination of certain exclusion criteria could be a reasonable method to decrease the number of patients who currently fail to receive adequate treatment.
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Bereczki et al. (2016) studied this question.
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