Why the study?
Does IV thrombolysis increase the risk of symptomatic intracranial hemorrhage in stroke patients with prior warfarin use?
Does IV thrombolysis increase the risk of symptomatic intracranial hemorrhage in stroke patients with prior warfarin use?
This editorial highlights a large registry study showing that IV thrombolysis appears safe in stroke patients with prior warfarin use, with no increased risk of symptomatic intracranial hemorrhage.
The study by Xian et al.,1 published in JAMA (June 27, 2012), adds to the growing literature on the safety of IV thrombolysis among stroke patients undergoing anticoagulation treatment. This study, which uses data from the American Heart Association Get With The Guidelines (GWTG)–Stroke Registry, concluded that there was no association between IV thrombolysis and symptomatic intracranial hemorrhage (SICH).1 These findings are in agreement with some2–4 but contrast with other studies (including 2 meta-analyses).5–8 The study by Xian et al. is the largest study to date drawing from hospitals throughout the United States, including 23,437 patients who received IV thrombolysis.1 Nearly 8% of these patients had prior warfarin use and 48.6% of the warfarin-treated patients who met the eligibility criteria did not receive IV thrombolysis.1
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Seet et al. (2012) studied this question.
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