Abstract Details

Title Case Series of Protamine Followed by Thrombolysis in Heparinized Acute Ischemic Stroke Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-016

Objective Anticoagulation is considered a contraindication to thrombolysis in acute ischemic stroke (AIS). Protamine is a rapid reversal agent for heparin, yet there are few reports of protamine reversal prior to thrombolysis in AIS.

Background We reviewed all 4231 patients (3780 in emergency department/451 inpatients) evaluated emergently in our system for AIS from October 2014 through September 2019 and noted any patient on therapeutic anticoagulation with heparin who was treated with protamine prior to thrombolysis.

Design/Methods n/a

Results A total of 5 patients (4 males, one female, average age 59) on therapeutic anticoagulation were treated with protamine prior to thrombolysis. 4 were inpatients and one presented via the emergency department after cardiac catheterization and transfer from another hospital. 4 were on heparin drip (PTT 26 to 136) and 1 was treated with heparin as part of a procedure (PTT >200). Average NIHSS was 10.4, range 3-22. Only one patient had an intracranial large vessel occlusion (LVO), the family declined thrombectomy. There were no intracranial hemorrhages on follow up imaging.

Conclusions Therapeutic heparin use impacts treatment options of AIS, but can be rapidly reversed with protamine. Thrombolysis after protamine reversal of heparin was safe in our patients. Prior reports of protamine use in AIS have emphasized severe impairment but this series suggests that disabling stroke with low NIHSS should be considered for thrombolysis. We did not review other types of anticoagulation reversal in AIS but speculate that thrombolysis could be safe in appropriate subtypes of anticoagulation after pharmacologic reversal. The unknown safety profile and costs of reversal agents might influence their use, but in anticoagulated AIS without LVO thrombolysis after reversal could be the only emergency therapy option.

Authors/Disclosures
Reid D. Taylor, MD (Mission Neurology Services) PRESENTER	Dr. Taylor has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Alexander Schneider, MD (Mission Hospital)	No disclosure on file

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Abstract Details