Clotting factors to treat thrombolysis-related symptomatic intracranial hemorrhage in acute ischemic stroke.

Abstract

BACKGROUND:

Symptomatic intracranial hemorrhage (sICH) occurs uncommonly after ischemic stroke therapy with tissue plasminogen activator (tPA). Clotting factor administration may be a treatment option.

OBJECTIVE:

To determine if treatment with clotting factors (fresh frozen plasma [FFP] or cryoprecipitate) was associated with improved outcomes in sICH.

METHODS:

We conducted a retrospective cohort study within University of Texas at Houston Stroke registry involving consecutive patients from February 1, 2007, to June 30, 2011, with tPA-related sICH, including cases with subsequent intra-arterial therapy. Outcomes were Modified Rankin Scale (mRS) score at discharge, death, and hematoma expansion.

RESULTS:

Of 921 patients treated with tPA, 48 (5.2%) had sICH and 45 met criteria for the study. Nineteen patients received clotting factors (42.2%; 18 received FFP and 7 received cryoprecipitate), whereas 26 (57.8%) patients received conservative management without clotting factors. None of the patients treated with clotting factors and only 2 of those who did not receive clotting factors had a good outcome, mRS score of 2 or less. All the patients treated with clotting factors and most of those not treated were left bedridden or dead (mRS score 4-6), 19 (100%) versus 22 (85%). Mortality was 9 (47.4%) versus 9 (34.6%), respectively. There was no difference in hematoma expansion between the 2 groups.

CONCLUSIONS:

We found no evidence that treatment for sICH with clotting factors has a favorable effect on clinical or radiological outcomes. However, the sample was small because of the low frequency of sICH. New treatments are urgently needed for this uncommon yet serious condition.

• Authors: Yazan J Alderazi, Niravkumar V Barot, Hui Peng, Farhaan S Vahidy, Digvijaya D Navalkele, Navdeep Sangha, Vivek Misra, Sean I Savitz
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 23 Issue 3 Pg. e207-14 (Mar 2014) ISSN: 1532-8511 [Electronic] United States
• PMID: 24321775 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• Coagulants
• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Aged
• Aged, 80 and over
• Blood Coagulation (drug effects)
• Brain Ischemia (blood, diagnosis, drug therapy, mortality)
• Coagulants (adverse effects, therapeutic use)
• Female
• Fibrinolytic Agents (adverse effects)
• Hospitals, University
• Humans
• Intracranial Hemorrhages (chemically induced, diagnosis, drug therapy, mortality)
• Male
• Middle Aged
• Registries
• Retrospective Studies
• Risk Factors
• Stroke (blood, diagnosis, drug therapy, mortality)
• Texas
• Thrombolytic Therapy (adverse effects, mortality)
• Time Factors
• Tissue Plasminogen Activator (adverse effects)
• Treatment Outcome