Mowla Ashkan, Kamal Haris, Lail Navdeep S, Vaughn Caila, Shirani Peyman, Mehla Sandhya, Rajabzadeh-Oghaz Hamidreza, Deline Christopher, Ching Marilou, Crumlish Annemarie, Sawyer Robert N
Stroke Division, Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York.
Stroke Division, Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York.
J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1414-1418. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.021. Epub 2017 Apr 21.
To determine the safety of intravenous (IV) recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke (AIS) who had a platelet count <100,000 /mm.
We reviewed the charts of all patients who received IV rtPA for AIS during a 9.6-year period at our stroke center. Those with platelets <100,000/mm were identified. Head computed tomography scans performed in 24-36 hours postthrombolysis were reviewed to evaluate the rate of symptomatic intracranial hemorrhage (sICH).
A total of 835 patients received IV rtPA for AIS during this period. A total of 5 patients were identified to have a platelet count <100,000/mm. One of them (20%) developed sICH post-IV tPA administration .The mean platelet count of those 5 patients was 63,000 ± 19,000/mm. To the best of our knowledge, only 21 thrombocytopenic patients have been reported to receive IV rtPA for AIS in the medical literature. Combining our 5 cases with 21 patients previously reported, we have 26 AIS patients who had a platelet count <100,000/mm and received IV rtPA, with 2 of them developing sICH (7.7 %). Comparing the rate of sICH among this group with the patients with normal platelet count in our cohort, there was no statistically significant difference (7.7% versus 6.04%, P value = .73).
IV rtPA for AIS might be safe in patients with platelet count <100,000/mm and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count.
确定血小板计数<100,000/mm³ 的急性缺血性卒中（AIS）患者静脉注射重组组织型纤溶酶原激活剂（rtPA）的安全性。
我们回顾了在我们卒中中心9.6年期间接受静脉rtPA治疗AIS的所有患者的病历。确定血小板计数<100,000/mm³ 的患者。对溶栓后24 - 36小时进行的头部计算机断层扫描进行回顾，以评估症状性颅内出血（sICH）的发生率。
在此期间，共有835例患者接受静脉rtPA治疗AIS。共确定5例患者血小板计数<100,000/mm³ 。其中1例（20%）在静脉注射tPA后发生sICH。这5例患者的平均血小板计数为63,000 ± 19,000/mm³ 。据我们所知，医学文献中仅报道了21例血小板减少患者接受静脉rtPA治疗AIS。将我们的5例病例与先前报道的21例患者合并，我们有26例AIS患者血小板计数<100,000/mm³ 并接受静脉rtPA治疗，其中2例发生sICH（7.7%）。将该组患者的sICH发生率与我们队列中血小板计数正常的患者进行比较，差异无统计学意义（7.7%对6.04%，P值 = 0.73）。
血小板计数<100,000/mm³ 的AIS患者静脉注射rtPA可能是安全的，在等待血小板计数结果时不延迟静脉rtPA给药是合理的，除非强烈怀疑血小板计数异常。
