Aggarwal Harsh R, Hassan Ameer E, Rodriguez Gustavo J, Suri M Fareed K, Taylor Robert A, Qureshi Adnan I
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota, MN 55455, USA.
J Vasc Interv Neurol. 2013 Dec;6(2):1-8.
To determine the rates of symptomatic intracerebral hemorrhages (sICH), parenchymal hematoma type 2 (PH2), and favorable outcomes in patients with borderline elevation of international normalized ratio (INR) or recent anticoagulation use prior to treatment with intravenous recombinant tissue plasminogen activator (IV rt-PA) for acute ischemic stroke.
Consecutive patients with acute ischemic stroke that received IV rt-PA were identified. History of recent use of anticoagulation and the INR at presentation and after use of thrombolytics, up to 72 h was recorded. Neuroimaging and clinical charts were reviewed for evidence of sICH. Outcomes were recorded at the time of discharge and on follow-up up to 6 months using the modified Rankin scale (mRS).
A total of 106 patients (mean age was 65.95 ± 15.29 years and 55.67% were men) were identified. Of these, 12 (11.3%) patients had initial INR elevation (1.2-1.7) and 12 (11.3%) patients that had recently received oral anticoagulation. The rate of PH2 was higher in patients on anticoagulation or with elevated initial INR compared to patients with normal INR and no history of anticoagulation (15.79% versus 2.30%, P = 0.023). In subgroup analyses, elevation of INR during the first 24 h and history of recent use of anticoagulation in a different analysis inversely correlated with favorable outcomes at discharge and at follow-up.
Borderline elevation in INR or recent use of anticoagulation before thrombolytic use can increase the rate of ICH in patients treated with IV rt-PA for acute ischemic stroke. These patients should cautiously receive thrombolytics for acute ischemic stroke as per the AHA/ASA Stroke Council guidelines.
确定国际标准化比值（INR）临界升高或近期使用抗凝剂的急性缺血性卒中患者在接受静脉注射重组组织型纤溶酶原激活剂（IV rt-PA）治疗前发生有症状性脑出血（sICH）、2型脑实质血肿（PH2）的发生率以及良好预后的情况。
确定接受IV rt-PA治疗的急性缺血性卒中连续患者。记录近期抗凝使用史以及就诊时和使用溶栓药物后直至72小时的INR。回顾神经影像学和临床图表以寻找sICH的证据。使用改良Rankin量表（mRS）在出院时和随访至6个月时记录结局。
共确定了106例患者（平均年龄65.95±15.29岁，55.67%为男性）。其中，12例（11.3%）患者初始INR升高（1.2 - 1.7），12例（11.3%）患者近期接受过口服抗凝治疗。与INR正常且无抗凝史的患者相比，接受抗凝治疗或初始INR升高的患者PH2发生率更高（15.79%对2.30%，P = 0.023）。在亚组分析中，不同分析中前24小时内INR升高和近期抗凝使用史与出院时和随访时的良好结局呈负相关。
INR临界升高或在溶栓治疗前近期使用抗凝剂可增加接受IV rt-PA治疗的急性缺血性卒中患者的脑出血发生率。这些患者应根据美国心脏协会/美国卒中协会卒中委员会指南谨慎接受急性缺血性卒中的溶栓治疗。
