title: Hemorrhagic complications after systemic thrombolysis in acute stroke patients with abnormal baseline coagulation.
abstract: OBJECTIVE
  As patients with abnormal baseline coagulation were excluded from the large randomized trials, the safety of intravenous thrombolysis after ischaemic stroke in this patient population remains controversial.
  
  
  METHODS
  We assessed the risk of symptomatic intracerebral hemorrhage (SICH) after systemic thrombolysis in patients with elevated baseline international normalized ratios (INRs) (≥1.3) or activated partial thromboplastin times (aPTT) (>37 s) using a prospectively recorded database from 2006 to 2010. An intracerebral hemorrhage leading to a deterioration of ≥4 points on the National Institutes of Health Stroke scale (NIHSS) was classified as symptomatic.
  
  
  RESULTS
  Amongst 688 patients (mean age, 72 years; median NIHSS, 11, median onset-to-treatment time, 135 min), 36 patients (5%) had an abnormal baseline coagulation. Twenty-nine of these patients had taken oral anticoagulants leading to elevated baseline INRs (median INR: 1.5; IQR 1.4-1.9), whereas seven patients had elevated aPTTs because of heparin therapy (n = 2), a coagulation disorder (n = 2), or for unknown reasons (n = 3). The rate of SICH did not differ significantly between patients with abnormal and normal baseline coagulation (4.4% vs. 0%; P = 0.6). Moreover, the in-hospital mortality was not significantly different between both treatment groups (8.3% in patients with abnormal baseline coagulation vs. 8.7% in patients with normal baseline coagulation, P = 1.0).
  
  
  CONCLUSIONS
  The risk of SICH following intravenous thrombolysis after ischaemic stroke does not appear to be increased in patients with abnormal baseline coagulation.
authors.affiliation: Department of Neurology, Klinikum Bremen-Mitte, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Brunner
authors.forename: B
authors.initials: B
authors.lastname: Tomandl
authors.forename: A
authors.initials: A
authors.lastname: Schröter
authors.forename: C
authors.initials: C
authors.lastname: Mellinghoff
authors.forename: A
authors.initials: A
authors.lastname: Haldenwanger
authors.forename: H
authors.initials: H
authors.lastname: Hildebrandt
authors.forename: A
authors.initials: A
authors.lastname: Kastrup
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000209:etiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006474:Hemorrhagic Disorders / Q000097:blood / Q000139:chemically induced / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator