Clin Exp Emerg Med.  2019 Jun;6(2):160-168. 10.15441/ceem.18.056.

Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator

Affiliations
  • 1Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. donghyuk.shinn@samsung.com
  • 2Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
  • 3Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA.
METHODS
This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed.
RESULTS
In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm³, P=0.020). The best cutoff platelet count was 195,000/mm³, and patients with platelet counts of < 195,000/mm³ had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm³.
CONCLUSION
Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.

Keyword

Cerebral infarction; Thrombolytic therapy; Intracranial hemorrhages; Hematologic tests

MeSH Terms

Administration, Intravenous*
Aspartate Aminotransferases
Brain
Cerebral Infarction*
Emergency Service, Hospital
Follow-Up Studies
Hematologic Tests*
Humans
Intracranial Hemorrhages*
L-Lactate Dehydrogenase
Logistic Models
Observational Study
Platelet Count
Retrospective Studies
Seoul
Stroke
Tertiary Care Centers
Thrombocytopenia
Thrombolytic Therapy
Tissue Plasminogen Activator*
Aspartate Aminotransferases
L-Lactate Dehydrogenase
Tissue Plasminogen Activator
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