Intravenous thrombolysis and platelet count

OBJECTIVETo study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 10/L is supported. METHODSIn this prospective multicenter, IVT register–based study, we compared PC with symp...

Full description

Saved in:

Bibliographic Details
Published in:	Neurology Vol. 90; no. 8; pp. e690 - e697
Main Authors:	Gensicke, Henrik, Al Sultan, Abdulaziz S, Strbian, Daniel, Hametner, Christian, Zinkstok, Sanne M, Moulin, Solène, Bill, Olivier, Zini, Andrea, Padjen, Visnja, Kägi, Georg, Pezzini, Alessandro, Seiffge, David J, Traenka, Christopher, Räty, Silja, Amiri, Hemasse, Zonneveld, Thomas P, Lachenmeier, Romina, Polymeris, Alexandros, Roos, Yvo B, Gumbinger, Christoph, Jovanovic, Dejana R, Curtze, Sami, Sibolt, Gerli, Vandelli, Laura, Ringleb, Peter A, Leys, Didier, Cordonnier, Charlotte, Michel, Patrik, Lyrer, Philippe A, Peters, Nils, Tatlisumak, Turgut, Nederkoorn, Paul J, Engelter, Stefan T
Format:	Journal Article
Language:	English
Published:	United States American Academy of Neurology 20-02-2018
Subjects:	acute ischemic-stroke Administration, Intravesical Aged Aged, 80 and over association clinical-practice Female guidelines health-care Hemorrhage - epidemiology Humans iv thrombolysis Male Middle Aged Neurologi Neurology Neurosciences Neurosciences & Neurology Neurovetenskaper Platelet Count professionals Prospective Studies Registries Risk Factors Stroke - blood Stroke - drug therapy Stroke - epidemiology Survival Analysis therapy thrombocytopenia Thrombocytopenia - epidemiology Thrombocytosis - epidemiology Thrombolytic Therapy - adverse effects tissue-plasminogen activator volume
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	OBJECTIVETo study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 10/L is supported. METHODSIn this prospective multicenter, IVT register–based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3–6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 × 10/L), thrombocytosis (>450 × 10/L), and normal PC (150–450 × 10/L [reference group]). Moreover, PC < 100 × 10/L was compared to PC ≥ 100 × 10/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated. RESULTSAmong 7,533 IVT-treated stroke patients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 × 10/L) was associated with increasing risk of sICH (ORadjusted 1.03, 95% CI 1.02–1.05) but decreasing risk of poor outcome (ORadjusted 0.99, 95% CI 0.98–0.99) and mortality (ORadjusted 0.98, 95% CI 0.98–0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (ORadjusted 1.73, 95% CI 1.24–2.43). However, the risk of poor outcome (ORadjusted 0.89, 95% CI 0.39–1.97) and mortality (ORadjusted 1.09, 95% CI 0.83–1.44) did not differ significantly. Thrombocytosis was associated with mortality (ORadjusted 2.02, 95% CI 1.21–3.37). Forty-four (0.3%) patients had PC < 100 × 10/L. Their risks of sICH (ORunadjusted 1.56, 95% CI 0.48–5.07), poor outcome (ORadjusted 1.63, 95% CI 0.82–3.24), and mortality (ORadjusted 1.38, 95% CI 0.64–2.98) did not differ significantly from those of patients with PC ≥ 100 × 10/L. CONCLUSIONLower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 10/L is challenged.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0028-3878 1526-632X
DOI:	10.1212/WNL.0000000000004982