Early Fibrinogen Degradation Coagulopathy Is Predictive of Parenchymal Hematomas in Cerebral rt-PA Thrombolysis

Trouillas, P; Derex, Laurent; Philippeau, Frédéric; Nighoghossian, Norbert; Honnorat, Jérôme; Hanss, Micel; Ffrench, Patrick; Adeleine, P.; Dechavanne, M

doi:10.1161/01.str.0000126040.99024.cf

Cited by 95 publications

(63 citation statements)

References 37 publications

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“…Finally, in a small series published recently consisting of 7 patients undergoing CEA after successful thrombolysis, 13 there was 1 postoperative intracranial hemorrhage but no other complications at 30 days. As has been previously described, 14 the half-life of recombinant tPA in the systemic circulation is short, and unless CEA/CAS is undertaken immediately after cessation of thrombolysis, this is unlikely to contribute significantly to any increased risk of bleeding in this patient category.…”

Section: Discussionmentioning

confidence: 78%

Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Koraen-Smith

Troëng

Björck

et al. 2014

Stroke

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Background and Purpose-Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke. Methods-Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid surgery and stenting during the study period. Results-The median time between thrombolysis and the carotid procedure was 10 days. Seventy-one patients underwent carotid endarterectomy, and 6 patients underwent carotid artery stenting. The 30-day death and stroke rate for the thrombolysis cohort was 2.5% (2 of 79), and for the whole cohort, it was 3.8% (139 of

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Section: Discussionmentioning

confidence: 78%

Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Koraen-Smith

Troëng

Björck

et al. 2014

Stroke

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“…Higher doses of thrombolytic can increase fibrinogen degradation products, which has been correlated with higher risks for bleeding. 7 Fewer hemorrhagic complications in prior retrospective studies with low-dose IA urokinase does substantiate a more conservative protocol when implementing this drug. 8 Significant hemorrhagic complications during endovascular treatment of tandem extracranial and intracranial occlusions have not been reported previously, largely because this subgroup of patients has not been included in trials of IA prourokinase, IA tPA, or mechanical embolectomy.…”

Section: Discussionmentioning

confidence: 94%

Factors Predicting Hemorrhagic Complications after Multimodal Reperfusion Therapy for Acute Ischemic Stroke

Vora

Gupta²,

Thomas³

et al. 2007

American Journal of Neuroradiology

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“…42,46 An early increase in fibrin degradation products has also been associated with increased risk of parenchymal hematoma. 47 Hypofibrinogenemia (fibrinogen level <150 mg/dL) at the time of sICH diagnosis has also been associated with hematoma expansion. 48 The coagulopathy produced by alteplase is not the only determinant of hemorrhage occurring within an infarct (hemorrhagic infarct); it is also encountered even without the use of thrombolytic or anticoagulant agents.…”

Section: Pathophysiology Of Alteplase-related Hemorrhagic Transformationmentioning

confidence: 99%

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Yaghi¹,

Willey²,

Cucchiara³

et al. 2017

Stroke

406

307

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Purpose— Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. Methods— A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. Results— sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes.

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Early Fibrinogen Degradation Coagulopathy Is Predictive of Parenchymal Hematomas in Cerebral rt-PA Thrombolysis

Cited by 95 publications

References 37 publications

Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke

Factors Predicting Hemorrhagic Complications after Multimodal Reperfusion Therapy for Acute Ischemic Stroke

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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