Acır İbrahim, Erdoğan Hacı Ali, Yayla Vildan, Taşdemir Nilay, Çabalar Murat
Department of Neurology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Neurology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
J Stroke Cerebrovasc Dis. 2018 May;27(5):1417-1419. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.032. Epub 2017 Nov 28.
Intravenous tissue plasminogen activator (IV tPA) was shown to be an effective treatment for acute ischemic stroke (AIS). According to stroke guidelines, there is no need to wait for the complete blood count (CBC) and coagulation test results before application of IV alteplase if there is no suspected coagulation disorder. In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented.
A 33-year-old male patient was admitted at the 2.5th hour of AIS symptoms onset with right hemiparesis and sensorimotor aphasia. Cranial computed tomography (CT) and diffusion magnetic resonance imaging did not reveal any abnormality. In his medical history, the patient did not have any contraindication for thrombolytic treatment. To avoid delays to thrombolytic therapy, blood samples were taken, and after that, IV bolus alteplase treatment was applied. During maintenance treatment, agitation and vomiting developed. The result of blood samples showed less than 26,000 mm platelet count and maintenance therapy was stopped. In control cranial CT, there was no hemorrhage. In the laboratory examination; anemia, low platelet count; increased indirect bilirubin, lactate dehydrogenase (LDH) levels were found, and fever was 38.4°C. Schistocytes were observed in peripheral blood smear and the patient was diagnosed as TTP.
Stroke guidelines recommend not to wait for the results of CBC and coagulation tests before IV tPA treatment in patients who do not have any history of coagulopathy disorder. If possible, before applying IV tPA we may wait for the results of coagulation and CBC tests, keeping in mind the diseaes with high mortality such as TTP.
静脉注射组织型纤溶酶原激活剂（IV tPA）被证明是治疗急性缺血性卒中（AIS）的有效方法。根据卒中指南，如果没有疑似凝血障碍，在应用静脉注射阿替普酶之前无需等待全血细胞计数（CBC）和凝血试验结果。在本研究中，报告了一名在溶栓治疗期间出现AIS和血栓性血小板减少性紫癜（TTP）症状的患者。
一名33岁男性患者在AIS症状发作后2.5小时入院，伴有右侧偏瘫和感觉运动性失语。头颅计算机断层扫描（CT）和扩散磁共振成像未发现任何异常。在其病史中，患者没有任何溶栓治疗的禁忌症。为避免延迟溶栓治疗，采集了血样，之后进行了静脉推注阿替普酶治疗。在维持治疗期间，出现了躁动和呕吐。血样结果显示血小板计数低于26,000/mm，维持治疗停止。在对照头颅CT中，没有出血。实验室检查发现贫血、血小板计数低；间接胆红素、乳酸脱氢酶（LDH）水平升高，体温为38.4°C。外周血涂片观察到裂体细胞，患者被诊断为TTP。
卒中指南建议，对于没有任何凝血障碍病史的患者，在静脉注射tPA治疗前无需等待CBC和凝血试验结果。如果可能，在应用静脉注射tPA之前，我们可以等待凝血和CBC试验结果，同时牢记TTP等高死亡率疾病。
