Intracranial hemorrhage complicating acute myocardial infarction in the era of thrombolytic therapy.
Cerebrovascular accidents are one of the most serious causes of morbidity in patients sustaining an acute myocardial infarction. In patients who do not receive thrombolytic therapy, the most common form of stroke is thromboembolic, occurring in up to 2.4% of patients, predominantly in those sustaining large anterior infarctions. In patients receiving thrombolytic therapy, intracranial hemorrhage is the most common form of stroke, occurring in 0.1% to 1.4%. Predisposing conditions for intracranial bleeding include low body weight, female sex, advanced age, use of oral anticoagulant medication before the administration of lytic therapy, diastolic blood pressure greater than 110 mm Hg, and the specific thrombolytic agent administered. Hematologic management of the patient sustaining a hemorrhagic cerebrovascular accident should include (1) discontinuance of thrombolytic therapy, anticoagulants, and antiplatelet agents and (2) infusion of cryoprecipitate to replenish fibrinogen. In certain cases, administration of fresh frozen plasma, protamine sulfate, and exogenous platelets may be required. Finally, evacuation of the hematoma may provide the most definitive form of treatment in selected cases.
Conrad
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Department of Medicine, State University of New York at Stony Brook, USA.
Feffer
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Rajan
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Freeman
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D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology*; D017809:Fatal Outcome; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors; D013300:Streptokinase / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D013300:Streptokinase