Hemorrhagic complications after off-label thrombolysis for ischemic stroke.
OBJECTIVE
Only 2% to 4% of patients with acute ischemic stroke receive thrombolytic therapy resulting from the current strict inclusion criteria among other issues. Safety of intravenous and intraarterial thrombolysis in off-label situations is controversially discussed. We sought to review the reports on such patients regarding intra- and extracranial hemorrhage.


RESULTS
A MEDLINE search for off-label uses of thrombolysis revealed reports on 273 patients treated with intraarterial or intravenous thrombolysis for ischemic stroke. Symptomatic intracranial hemorrhage occurred in 19 of 273 patients (6.95%) and extracranial hemorrhage in 17 of 273 (6.22%).


CONCLUSIONS
These data suggest that the overall bleeding risk in off-label thrombolysis may not be as high as presumed. However, the small number of patients in each group and the likely underreporting of worse outcomes preclude drawing any conclusion as to specific treatment recommendations. Selected patients might benefit, however, from thrombolysis in situations not currently considered in the inclusion criteria. To obtain a meaningful database, a registry for off-label thrombolysis should be created.
Aleu
Aitziber
A
Department of Neurology, Neurointensive Care Unit, University of Heidelberg, Heidelberg, Germany. aitziberaleu@gmail.com
Mellado
Patricio
P
Lichy
Christoph
C
Köhrmann
Martin
M
Schellinger
Peter D
PD
D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects
D010959:Tissue Plasminogen Activator