医学
溶栓
肝素
改良兰金量表
冲程(发动机)
纤溶剂
血运重建
外科
脑梗塞
组织纤溶酶原激活剂
麻醉
内科学
心肌梗塞
缺血
缺血性中风
工程类
机械工程
作者
Mandy J. Binning,Christina R. Maxwell,Michael McAree,Erol Veznedaroglu,Daniel R. Felbaum,Adam S Arthur,Nitin Goyal,Stacey Q Wolfe,Christine Tschoe,R. Webster Crowley,Elad I. Levy,Kunal Vakharia,H Hamid,Aditya S. Pandey,Badih Daou,Rabih G. Tawk,Andrew J. Ringer,Kenneth Liebman
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2021-01-13
卷期号:88 (4): 746-750
被引量:3
标识
DOI:10.1093/neuros/nyaa530
摘要
Abstract BACKGROUND Intravenous (IV) alteplase with mechanical thrombectomy has been found to be superior to alteplase alone in select patients with intracranial large vessel occlusion. Current guidelines discourage the use of antiplatelet agents or heparin for 24 h following alteplase. However, their use is often necessary in certain circumstances during thrombectomy procedures. OBJECTIVE To study the safety and outcomes in patients who received blood thinning medications for thrombectomy after IV Tissue-Type plasminogen activator (tPA). METHODS This is a multicenter retrospective review of the use of antiplatelet agents and/or heparin in patients within 24 h following tPA administration. Patient demographics, comorbidities, bleeding complications, and discharge outcomes were collected. RESULTS A series of 88 patients at 9 centers received antiplatelet medications and/or heparin anticoagulation following IV alteplase for revascularization procedures requiring stenting. The mean National Institutes of Health Stroke Scale (NIHSS) on admission was 14.6. Reasons for use of a stent included internal carotid artery occlusion in 74% of patients. Thrombolysis in cerebral infarction (TICI) 2b-3 revascularization was accomplished in 90% of patients. The rate of symptomatic intracranial hemorrhage (sICH) was 8%; this was not significantly different than the sICH rate for a matched group of patients not receiving antiplatelets or heparin during the same time frame. Functional independence at 90 d (modified Rankin Scale 0-2) was seen in 57.8% of patients. All-cause mortality was 12%. CONCLUSION The use of antiplatelet agents and heparin for stroke interventions following IV alteplase appears to be safe without significant increased risk of hemorrhagic complications in this group of patients when compared to control data and randomized controlled trials.
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