Key result
Thrombocytopenia is linked to ~73% higher sICH risk after IV thrombolysis for stroke.
Why the study?
The effect of platelet count on bleeding risk and outcome in stroke patients treated with IV thrombolysis and the justification for withholding IVT in patients with platelet count < 100 × 109/L was uncertain.
Does low platelet count (<100 × 10^9/L) increase the risk of symptomatic intracranial hemorrhage, poor outcome, or mortality in acute ischemic stroke patients treated with IV thrombolysis?
Cohort (n=7,533)
Yes
Does low platelet count (<100 × 10^9/L) increase the risk of symptomatic intracranial hemorrhage, poor outcome, or mortality in acute ischemic stroke patients treated with IV thrombolysis?
Odds Ratio: 1.73 (95% CI 1.24–2.43)
Absolute Event Rate: 7.6% vs 4.4%
p-value: p=0.002
In acute ischemic stroke patients treated with IV thrombolysis, lower platelet count increases the risk of symptomatic intracranial hemorrhage but does not worsen functional outcome or mortality, challenging the guideline recommendation to withhold IVT in patients with platelet counts <100 × 10^9/L.
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May warrant caution with IV thrombolysis in thrombocytopenic stroke patients; hypothesis-generating and should not yet change practice.
Gensicke et al. (2018) conducted a cohort in Acute ischemic stroke (n=7,533). Thrombocytopenia (<150 × 10^9/L) vs. Normal platelet count (150-450 × 10^9/L) was evaluated on Symptomatic intracranial hemorrhage (sICH) (OR 1.73, 95% CI 1.24-2.43, p=0.002). Thrombocytopenia (<150 × 10^9/L) was associated with an increased risk of symptomatic intracranial hemorrhage (adjusted OR 1.73) compared to normal platelet count in stroke patients treated with IV thrombolysis.
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