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Caruso P, Furlanis G, Ridolfi M, Ajcevic M, Naccarato M, Manganotti P. Safety of Early Repeated Thrombolysis. Neurologist 2019; 24:143-145. [DOI: 10.1097/nrl.0000000000000239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adverse outcome of early recurrent ischemic stroke secondary to atrial fibrillation after repeated systemic thrombolysis. Case Rep Vasc Med 2013; 2013:371642. [PMID: 23984177 PMCID: PMC3748420 DOI: 10.1155/2013/371642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission. Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.
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Alhazzaa M, Sharma M, Blacquiere D, Stotts G, Hogan M, Dowlatshahi D. Thrombolysis Despite Recent Stroke. Stroke 2013; 44:1736-8. [DOI: 10.1161/strokeaha.111.000818] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Thrombolysis in ischemic stroke is contraindicated in patients who have had a stroke within 3 months. However, it is unclear whether thrombolytic therapy is associated with adverse outcomes in this population. We report the characteristics and outcomes of patients treated with systemic recombinant tissue-type plasminogen activator in the context of known or unknown recent stroke.
Methods—
We identified patients who received recombinant tissue-type plasminogen activator despite recent stroke (within 3 months of acute thrombolysis). Clinical and radiological findings were collected, including early neurological worsening and hemorrhagic transformation on unenhanced computed tomography at 24 hours. Clinical outcome measured by modified Rankin Scale was determined at 3 months from onset.
Results—
Six patients presenting with acute stroke within 3 months of previous stroke were identified (median age, 76 years; median National Institutes of Health Stroke Scale, 8.5). Hemorrhagic transformation was seen in the follow-up computed tomography scan in 3 of 6 cases: all were hemorrhagic transformation 1 (petechial hemorrhage), asymptomatic, and mostly located within the area of subacute infarction. There was no early neurological deterioration, and 3 patients had modified Rankin Scale ≤2 after 3 months.
Conclusions—
In our center, we thrombolysed 6 patients despite recent stroke. Three patients had asymptomatic petechial hemorrhagic transformation within the area of subacute infarct, without apparent neurological worsening. Prospective studies are needed to explore the possible safety of tissue-type plasminogen activator in the context of previous subacute stroke in otherwise eligible patients.
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Affiliation(s)
- Mohammed Alhazzaa
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mukul Sharma
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dylan Blacquiere
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grant Stotts
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew Hogan
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- From the Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Montaner J. Response to Letter by Topakian et al. Stroke 2006. [DOI: 10.1161/01.str.0000240077.28905.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joan Montaner
- Neurovascular Research Laboratory, Stroke Unit, Neurology Department, Vall d’Hebron Hospital, Barcelona, Spain
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