Intravenous Thrombolysis in Anticoagulated and Thrombocytopenic Ischemic Stroke Patients Does Not Increase the Risk of Intracerebral Hemorrhage (P4.271)

Objective: To determine if IV rt-PA is safe in therapeutically anticoagulated or thrombocytopenic patients. Background: IV rt-PA guidelines generally exclude therapeutically anticoagulated or thrombocytopenic patients. However, these exclusion criteria may limit IV thrombolytic therapy to patients who might benefit. Design/Methods: Retrospective analysis of IV rt-PA treated patients receiving oral anticoagulation (warfarin (INR ≥1.7) or a novel oral anticoagulant (NOAC)), therapeutic heparin, low-molecular weight heparin (LMWH), or with thrombocytopenia (platelets Results: 67 patients were identified. 33 patients received therapeutic warfarin and one had a coagulopathy (unclear etiology). In these patients, mean INR was 2.2 (range 1.7–3). 5 patients received therapeutic IV heparin, 6 full dose (1 mg/kg BID) LMWH, and 10 therapeutic NOACs (3 dabigatran, 4 rivaroxoban, 3 apixiban). 12 patients had thrombocytopenia (mean platelet count 77K). 7 patients received adjunct intra-arterial (IA) rt-PA, and 6 thrombectomy. There were 3 sICH (4.5%). In all cases there were mitigating factors that contributed (undiagnosed malignancy (n=1), adjunctive IA rt-PA (n=1), incorrect time of onset (n=1)). Two patients developed minor bleeding complications with no clinical effect (hematoma at catheter site). 12 patients (17.9%) died. Conclusions: These data suggest that IV rt-PA can be safely administered in coagulopathic and thrombocytopenic patients. Although rates of sICH and mortality were similar to the NINDS cohort, caution may be needed to identify certain hemorrhagic risk factors. Routine exclusion of anticoagulated or thrombocytopenic patients is not supported and the use of IV rt-PA in these patients may increase the eligibility for acute stroke therapy, particularly at institutions where IA therapy is unavailable. Disclosure: Dr. Barazangi has received personal compensation for activities with Genentech. Dr. Sorensen has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Yee has nothing to disclose. Dr. Ke has nothing to disclose. Dr. Rose has received personal compensation from Boehringer Ingelheim for speakers bureau services. Dr. Grosvenor has nothing to disclose. Dr. Bedenk has nothing to disclose. Dr. Fernandes has nothing to disclose. Dr. Tong has nothing to disclose.