Thromboelastography is a method of measuring whole-blood coagulation changes and has been used to guide therapy and monitor changes in a variety of disease states. However, few studies have investigated the thromboelastographic changes experienced in a patient who has received alteplase for an acute ischemic stroke. This pilot study sought to describe the effect of alteplase on the thromboelastogram tracings of patients experiencing an acute ischemic stroke.
This was an institutional review board–approved prospective cohort study. Patients who presented to the emergency department with symptoms of acute ischemic stroke and received intravenous alteplase were evaluated for inclusion. Blood samples were obtained before alteplase administration and at 30, 60, 90, 120, and 150 minutes after alteplase administration. In addition, baseline variables collected included patient age, sex, prothrombin time, partial thromboplastin time, and the use of pretreatment anticoagulants or antiplatelet agents. Patients were also followed throughout their hospital stay for development of intracranial hemorrhage.
A total of 7 patients were included in the analysis. At baseline, thromboelastogram parameters of all patients were within the normal range. The maximum inhibition of fibrin buildup was seen at 30 minutes after the start of alteplase infusion, and the lowest clot strength was observed at 60 minutes after initiation of alteplase. Most patients return to near baseline parameters within 150 minutes of alteplase initiation; however, 2 patients did not return to their baseline values within the 150-minute time frame.
Our study suggests that thromboelastogram (TEG) is a useful tool for determining changes in the coagulation system of patients whom have received recombinant tissue plasminogen activator (rt-PA). Further study is needed to determine if TEG can be used to predict those patients who may be at higher risk of adverse events because of rt-PA.
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- Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 870-947
- Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.N Engl J Med. 1995; 333: 1581-1587
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N Engl J Med. 2008; 359: 1317-1329
- Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS).JAMA. 1995; 274: 1017-1025
- Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.Lancet. 1998; 352: 1245-1251
- Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies.Stroke. 2012; 43: 2904-2909
- Early evaluation of acute traumatic coagulopathy by thrombelastography.Transl Res. 2009; 154: 34-39
- Thrombelastography monitoring of resistance to enoxaparin anticoagulation in thrombophilic pregnancy patients.Thromb Res. 2007; 120: 367-370
- Post interventional cardiology urinary thromboxane correlates with platelet mapping detected aspirin resistance.Thromb Res. 2010; 125: e118-e122
- Measurement of functional fibrinogen levels using the thrombelastograph.J Clin Anesth. 2008; 20: 186-190
- Detection of tPA-induced hyperfibrinolysis in whole blood by RapidTEG, KaolinTEG, and functional fibrinogenTEG in healthy individuals.Clin Appl Thromb Hemost. 2012; 18: 638-644
- Thromboelastographic studies in cerebral infarction.Stroke. 1974; 5: 350-354
- Thromboelastography in patients with acute ischemic stroke.Int J Stroke. 2012; ([epub ahead of print] Sep 27. 10.1111/j.1747-4949.2012.00919.x.)
Published online: January 21, 2014
Accepted: November 3, 2013
Received in revised form: October 7, 2013
Received: June 26, 2013
Grant support: None.
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.