Usefulness of checking platelet count before thrombolysis in acute ischemic stroke.
OBJECTIVE
Thrombolysis for acute ischemic stroke is strikingly time sensitive. Current guidelines require confirmation of a platelet count > or =100,000 before thrombolysis; however, obtaining this laboratory test may delay treatment.


METHODS
We queried our hospital database to identify patients with ICD-9 codes consistent with acute ischemic stroke from 2000 to 2005 and to determine platelet counts in these patients. Medical charts of patients with platelet counts <100,000 were reviewed to determine whether the patient had a known history of thrombocytopenia or conditions associated with thrombocytopenia.


RESULTS
A total of 1752 patients were identified, and 82 (4.7%) had a platelet count <100,000 at stroke onset. Only 6/1752 (0.3%) had a platelet count <100,000 which was not suspected based on initial history. All of these 6 patients had only mildly decreased platelet counts.


CONCLUSIONS
An unsuspected platelet count <100,000 was found in 0.3% of patients at stroke presentation. In patients without a history of thrombocytopenia or predisposing factors, the benefit of earlier thrombolysis may outweigh the bleeding risk of inadvertently treating a patient with thrombocytopenia.
Cucchiara
Brett L
BL
Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu
Jackson
Bryon
B
Weiner
Mark
M
Messe
Steven R
SR
D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010976:Platelet Count; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors
D005343:Fibrinolytic Agents