Key result
Immediate thrombolysis reveals unexpected coagulopathies in only ~2% of stroke patients, without excess bleeding.
Why the study?
Waiting for coagulation test results can delay time-dependent intravenous thrombolysis for acute ischemic stroke. Initiating thrombolysis without waiting for coagulation test results had not been evaluated in South America, where excessive alcohol consumption may increase the prevalence of unrecognized chronic liver disease.
What is the frequency of unsuspected coagulation abnormalities and associated clinical outcomes when initiating intravenous thrombolysis without waiting for coagulation test results in patients with acute ischemic stroke in Chile?
Cohort (n=480)
No
What is the frequency of unsuspected coagulation abnormalities and associated clinical outcomes when initiating intravenous thrombolysis without waiting for coagulation test results in patients with acute ischemic stroke in Chile?
In a Chilean tertiary stroke center, unsuspected coagulation abnormalities among acute ischemic stroke patients receiving intravenous thrombolysis were rare (1.88%) and not associated with worse 3-month outcomes or increased symptomatic intracerebral hemorrhage, supporting guideline recommendations to initiate thrombolysis without awaiting coagulation test results.
The effectiveness of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is time-dependent, and waiting for coagulation tests (COT) may delay treatment initiation. In several countries, IVT is initiated without waiting COT results; this approach has not been evaluated in South America. In this region, excessive alcohol consumption may increase the prevalence of unrecognized chronic liver disease. To determine the frequency of unsuspected coagulation abnormalities among patients with AIS treated with IVT at a single tertiary care center in Chile. A prospective analysis of all patients treated with IVT at Clínica Alemana between June 2016 and July 2025, assessing the proportion of individuals with unexpected coagulation abnormalities. A total of 480 patients with AIS received IVT. The COTs were normal in 445 patients (92.7%), abnormal in 9 (1.88%), and incomplete or not performed in 26 (5.42%). No clinical differences were observed among the three groups. Patients with coagulation abnormalities or incomplete/not performed COT were significantly less frequent in the Emergency Room (ER) during the coronavirus disease 2019 (COVID-19) pandemic (p = 0.001). Among those with abnormal COT results, significant differences were found in international normalized ratio (INR) values (p < 0.000) and platelet count (p = 0.001). The functional outcomes at 3 months, as well as mortality and rate of symptomatic intracerebral hemorrhage, did not differ across groups. Unexpected coagulation disorders are an infrequent finding in patients with AIS treated with IVT at our center in Santiago, Chile. Therefore, blood test results should not be awaited before initiating IVT.
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Brunser et al. (2026) conducted a cohort in Acute ischemic stroke (n=480). Abnormal baseline coagulation tests (INR ≥1.7 or platelet count <100,000/mm³) during intravenous thrombolysis vs. Normal baseline coagulation tests was evaluated on Frequency of unsuspected coagulation test abnormalities (INR ≥1.7 or platelet count <100,000/mm³) at admission. Intravenous thrombolysis initiated without waiting for laboratory results revealed unexpected coagulation abnormalities in only 1.88% of acute ischemic stroke patients, with no increase in sICH.
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