Systemic thrombolysis in stroke patients with abnormal baseline coagulation showed similar rates of symptomatic intracerebral hemorrhage compared to normal coagulation (4.4% vs. 0%; P=0.6).
Cohort (n=688)
Does intravenous thrombolysis increase the risk of symptomatic intracerebral hemorrhage in acute ischemic stroke patients with abnormal baseline coagulation compared to normal coagulation?
Intravenous thrombolysis does not appear to significantly increase the risk of symptomatic intracerebral hemorrhage in acute ischemic stroke patients with mildly abnormal baseline coagulation.
Absolute Event Rate: 4.4% vs 0%
p-value: p=0.6
BACKGROUND AND PURPOSE: As patients with abnormal baseline coagulation were excluded from the large randomized trials, the safety of intravenous thrombolysis after ischaemic stroke in this patient population remains controversial. METHODS: We assessed the risk of symptomatic intracerebral hemorrhage (SICH) after systemic thrombolysis in patients with elevated baseline international normalized ratios (INRs) (≥1.3) or activated partial thromboplastin times (aPTT) (>37 s) using a prospectively recorded database from 2006 to 2010. An intracerebral hemorrhage leading to a deterioration of ≥4 points on the National Institutes of Health Stroke scale (NIHSS) was classified as symptomatic. RESULTS: Amongst 688 patients (mean age, 72 years; median NIHSS, 11, median onset-to-treatment time, 135 min), 36 patients (5%) had an abnormal baseline coagulation. Twenty-nine of these patients had taken oral anticoagulants leading to elevated baseline INRs (median INR: 1.5; IQR 1.4-1.9), whereas seven patients had elevated aPTTs because of heparin therapy (n = 2), a coagulation disorder (n = 2), or for unknown reasons (n = 3). The rate of SICH did not differ significantly between patients with abnormal and normal baseline coagulation (4.4% vs. 0%; P = 0.6). Moreover, the in-hospital mortality was not significantly different between both treatment groups (8.3% in patients with abnormal baseline coagulation vs. 8.7% in patients with normal baseline coagulation, P = 1.0). CONCLUSIONS: The risk of SICH following intravenous thrombolysis after ischaemic stroke does not appear to be increased in patients with abnormal baseline coagulation.
Brunner et al. (Tue,) conducted a cohort in Acute ischaemic stroke (n=688). Systemic thrombolysis with abnormal baseline coagulation vs. Systemic thrombolysis with normal baseline coagulation was evaluated on Symptomatic intracerebral hemorrhage (SICH) (p=0.6). Systemic thrombolysis in stroke patients with abnormal baseline coagulation showed similar rates of symptomatic intracerebral hemorrhage compared to normal coagulation (4.4% vs. 0%; P=0.6).