Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada.
Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
Can J Neurol Sci. 2021 Jan;48(1):38-46. doi: 10.1017/cjn.2020.138. Epub 2020 Jul 10.
Guidelines are lacking for management of acute ischemic stroke and stroke prevention in patients with immune thrombocytopenia (ITP). Our aim is to highlight the dilemma inherent in managing patients with both significant bleeding and thrombotic risk factors. In this review, we present two patients with history of ITP who presented with acute ischemic stroke and received tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT), a rare management strategy in this patient population. In addition, we identified 27 case reports of ischemic stroke in patients with ITP; none of them received tPA or EVT. Furthermore, there are 92 patients with significant thrombocytopenia with no available data regarding the cause of thrombocytopenia, who were acutely treated with tPA or EVT. Conclusive evidence cannot be determined based on these limited number of cases. Future multicenter prospective cohort studies in patients with ITP are needed to provide better evidence-based treatment plans. At present, treatment of acute ischemic stroke in patients with ITP requires close collaboration between hematology and vascular neurology experts to find a balance between the benefit and risk of hemorrhagic complications.
指南缺乏对免疫性血小板减少症 (ITP) 患者的急性缺血性脑卒中的管理和脑卒中预防。我们的目的是突出管理具有重大出血和血栓形成危险因素的患者所固有的困境。在这篇综述中，我们介绍了两名有 ITP 病史的患者，他们因急性缺血性脑卒中接受了组织型纤溶酶原激活物 (tPA) 和血管内血栓切除术 (EVT)，这是该患者群体中罕见的治疗策略。此外，我们还确定了 27 例 ITP 患者的缺血性脑卒中病例报告；他们都没有接受 tPA 或 EVT。此外，有 92 名血小板计数显著降低的患者，没有关于血小板减少症病因的可用数据，他们接受了 tPA 或 EVT 的急性治疗。基于这些有限数量的病例，无法确定明确的结论性证据。需要在 ITP 患者中开展多中心前瞻性队列研究，以提供更好的基于证据的治疗方案。目前，治疗 ITP 患者的急性缺血性脑卒中需要血液学和血管神经病学专家之间的密切合作，以在出血并发症的获益和风险之间找到平衡。
