Repeated thrombolysis for chronologically separated ischemic strokes: a case series.
OBJECTIVE
Recombinant tissue plasminogen activator is used for the treatment of acute myocardial infarction, pulmonary embolism, and acute ischemic stroke. With many years since approval of the drug and an aging population, chances increase that patients are treated twice for chronologically separated events.


METHODS
We identified patients from the prospective Erlangen Stroke and Thrombolysis Database who received repeated thrombolysis for acute ischemic stroke. Baseline demographic data and clinical, laboratory, and imaging findings were analyzed. Functional outcome was assessed after 3 months.


RESULTS
Eight patients treated twice and one patient with 3 treatments were identified. The median time span between first and second thrombolysis was 10 (3 to 48) months. All patients had a favorable outcome after the first treatment, and 67% of patients had a favorable outcome after the second thrombolysis. Neither allergic reactions nor other immunoreactive events were observed.


CONCLUSIONS
Repeated administration of recombinant tissue plasminogen activator for chronologically separate ischemic strokes does not appear to be associated with severe immune reactions. Larger case numbers are needed to evaluate safety and efficacy of repeated systemic thrombolysis.
Sauer
Roland
R
Huttner
Hagen B
HB
Breuer
Lorenz
L
Engelhorn
Tobias
T
Schellinger
Peter D
PD
Schwab
Stefan
S
Köhrmann
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator