Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Acute thrombocytopenia after tissue plasminogen activator for stroke: A Case Report
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (12:00 PM-1:00 PM)
4-012
Acute thrombocytopenia has not been reported following tissue plasminogen activator (tPA) for acute ischemic stroke.   
Transient coagulopathy with decreased fibrinogen after tPA is well described.  Acute thrombocytopenia has been reported with combination thrombolytics and antiplatelet agents for myocardial infarction.  
An 88-year-old right-handed female with a history of atrial fibrillation developed acute left sided weakness, forced rightward gaze deviation, and neglect.  She received a standard dose of tPA. She was found to have right internal carotid artery and proximal right middle cerebral artery occlusions and underwent emergent thrombectomy with successful TICI IIb revascularization.  Her platelet count was 146 K/uL on admission and her INR was 1.2 five hours after tPA was given. Ten hours after tPA was administered, her platelet count decreased to 15 K/uL and her fibrinogen was 149 mg/dL.  Thrombocytopenia was confirmed on repeat evaluation.  She was transfused two units of platelets. Fourteen hours after tPA her fibrinogen had improved to 249 mg/dL and sixteen hours after tPA her platelet count improved to 222 K/uL.  She was noted to have scattered ecchymosis and petechial hemorrhages the day after tPA was given.  She underwent extensive workup for heparin induced thrombocytopenia and disseminated intravascular coagulation, which was unremarkable.  The patient had no history of alcohol abuse or liver disease and her liver enzymes were normal. She had no known history of thrombocytopenia. The hematology team felt her thrombocytopenia was secondary to transient coagulopathy after tPA. 
NA
This is the first case report of acute thrombocytopenia after tPA for acute ischemic stroke. The bleeding and mortality risk associated with thrombocytopenia after tPA is unknown.
Authors/Disclosures
Jonathan Morena, DO (Duke, Neurology)
PRESENTER 		The institution of Dr. Morena has received research support from Grifols.
No disclosure on file
Tamara Strohm, MD Dr. Strohm has nothing to disclose.