Department of Neurology, West Virginia University, Morgantown, West Virginia.
Health Science Library, West Virginia University, Morgantown, West Virginia.
J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104283. doi: 10.1016/j.jstrokecerebrovasdis.2019.06.041. Epub 2019 Jul 17.
Administering intravenous IV tissue plasminogen activator (tPA) is the recommended standard of care in acute ischemic stroke (AIS), although it is not recommended to administer intravenous thrombolysis with tPA following heparin reversal with protamine sulfate in patients with AIS.
We describe a case series of three patients and the most comprehensive literature review published to date in this specific subset of AIS patients undergoing thrombolysis following heparin reversal with protamine sulfate. The literature review was based on a scoping review methodology performed on four databases; PubMed, CINAHL, Web of Science, and Cochrane Library. All sources were searched from the inauguration of the database until February 2019. A total of six articles involving eight patients were identified.
The primary safety outcome of no symptomatic intracranial hemorrhage (sICH) was met in all eleven patients, although only seven cases had a good functional outcome at 3 months.
In appropriately selected AIS patients, coagulopathy correction appears to be safe from an sICH standpoint and may be beneficial. However, given the potential for bias with observational databases, case reports and case series, extreme caution is warranted in applying these results to routine clinical practice.
在急性缺血性脑卒中（AIS）患者中，静脉注射 IV 组织型纤溶酶原激活物（tPA）是推荐的标准治疗方法，尽管不建议在 AIS 患者使用硫酸鱼精蛋白逆转肝素后给予 tPA 静脉溶栓。
我们描述了三例患者的病例系列，并对迄今为止在接受肝素逆转后进行溶栓的 AIS 患者这一特定亚组进行了最全面的文献综述。文献综述基于对四个数据库（PubMed、CINAHL、Web of Science 和 Cochrane Library）进行的范围综述方法进行。所有来源均从数据库成立之日起搜索至 2019 年 2 月。共确定了 6 篇涉及 8 例患者的文章。
所有 11 例患者的主要安全性结局（无症状性颅内出血[sICH]）均得到满足，尽管只有 7 例在 3 个月时有良好的功能结局。
在适当选择的 AIS 患者中，从 sICH 的角度来看，凝血功能异常的纠正似乎是安全的，并且可能是有益的。然而，鉴于观察性数据库、病例报告和病例系列可能存在偏倚，在将这些结果应用于常规临床实践时应格外小心。
