Waiting for platelet counts causes unsubstantiated delay of thrombolysis therapy.

Abstract:

BACKGROUND:Platelet counts (PCs) <100,000/µl are considered as a contraindication for intravenous thrombolysis (IVT). While US guidelines recommend IVT initiation before the availability of clotting tests, the guidelines of the European Stroke Organization give no such practical advice. We aimed to assess the incidence of thrombocytopenia in IVT patients, outcome after thrombolysis in affected patients and the time gained by initiating treatment prior to availability of PC results. METHODS:All patients with thrombocytopenia were identified in our prospectively acquired thrombolysis database. Baseline demographic data, intracerebral hemorrhage rates as well as functional outcome were assessed. The median time between initiation of thrombolysis and availability of PCs was calculated. RESULTS:Of 625 IVT patients, 3 (0.5%) had thrombocytopenia at stroke onset. None of them developed intracerebral hemorrhage (ICH) or died during the follow-up. Waiting for PCs would have delayed treatment in 72.4% of the patients, with a median hypothetical delay of 22 min (interquartile range: 11-41 min). CONCLUSIONS:To date, there are no sufficient data to evaluate the ICH risk in thrombocytopenic patients. However, thrombocytopenia is rare in IVT patients. Thus, generally waiting for PC results prior to initiation of IVT is not warranted. Avoiding this significant delay yields shorter door-to-needle times and potentially more effective treatment.

journal_name

Eur Neurol

journal_title

European neurology

authors

Breuer L,Huttner HB,Kiphuth IC,Ringwald J,Hilz MJ,Schwab S,Köhrmann M

doi

10.1159/000345702

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

317-20

issue

5

eissn

0014-3022

issn

1421-9913

pii

000345702

journal_volume

69

pub_type

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