Background
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.
Methods
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.
Results
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.
Conclusions
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.
Key Words
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Article info
Publication history
Published online: January 21, 2014
Accepted:
November 3,
2013
Received in revised form:
October 7,
2013
Received:
June 26,
2013
Footnotes
Grant support: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.001
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
