title: Thrombolytic-associated coagulopathy and management dilemmas: a review of two cases.
abstract: Thrombolytic therapy improves the overall outcome of many patients with acute ischemic stroke, but it is associated with complications such as symptomatic intracranial hemorrhage. Several factors predict the risk of hemorrhage. Dramatic changes in the coagulation profile following thrombolytic therapy have not been well studied. However, it is unknown if commonly used laboratory tests for coagulation are of predictive value. Yet these tests are commonly requested to predict or treat symptomatic intracranial hemorrhage. When such tests are abnormal, they may present a management dilemma. In this report, we present two cases of coagulopathy following thrombolytic therapy without symptomatic intracranial hemorrhage that were managed differently. Our report suggests that dramatic changes occur in the coagulation profile of patients who receive thrombolytic therapy, but may not clearly predict symptomatic intracranial hemorrhage. Therefore, other factors should be considered when managing these patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center, 6431 Fannin MSB 2.136, Houston, TX 77573, USA. Orieji.C.Illoh@uth.tmc.edu
authors.forename: Orieji C
authors.initials: OC
authors.lastname: Illoh
authors.forename: Kachi
authors.initials: K
authors.lastname: Illoh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy; D019934:International Normalized Ratio; D007442:Intubation, Intratracheal; D010314:Partial Thromboplastin Time; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator