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Feasibility of IA Thrombolysis for Acute Ischemic Stroke Among Anticoagulated Patients

Abstract

Background and purpose

Limited information exists regarding thrombolysis among anticoagulated acute stroke patients. We present data from three consecutive patients, on active warfarin therapy, treated with intra-arterial reteplase.

Cases

All patients were screened for the presence of intracranial hemorrhage. Warfarin was reversed with fresh frozen plasma in all patients and cerebral angiography and intra-arterial administration of reteplase was performed. Computed tomographic scans were performed to detect any subsequent intracranial hemorrhage. Ages ranged from 58 to 79 years with initial National Institutes of Health Stroke Scale scores ranging from 12 to 17. Baseline international normalized ratios (INRs) were 1.99–2.25. None of the patients suffered from intracranial hemorrhage following thrombolysis, and two of the patients experienced early neurological improvement.

Conclusion

Low dose, intra-arterial reteplase following acute reversal of elevated INR is feasible and may offer a potential treatment for patients suffering with acute ischemic stroke while receiving active warfarin treatment.

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Acknowledgements

The authors have no additional acknowledgements or financial disclosures to state. This article does include discussion of the off-label use of intra-arterial reteplase for stroke treatment.

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Correspondence to Nazli Janjua.

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Janjua, N., Alkawi, A., Georgiadis, A. et al. Feasibility of IA Thrombolysis for Acute Ischemic Stroke Among Anticoagulated Patients. Neurocrit Care 7, 152–155 (2007). https://doi.org/10.1007/s12028-007-0027-7

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  • DOI: https://doi.org/10.1007/s12028-007-0027-7

Keywords

  • Thrombolysis
  • Intraarterial
  • Stroke
  • Acute ischemic
  • Coagulopathy
  • Warfarin