title: Thrombolysis despite recent stroke: a case series.
abstract: OBJECTIVE
  Thrombolysis in ischemic stroke is contraindicated in patients who have had a stroke within 3 months. However, it is unclear whether thrombolytic therapy is associated with adverse outcomes in this population. We report the characteristics and outcomes of patients treated with systemic recombinant tissue-type plasminogen activator in the context of known or unknown recent stroke.
  
  
  METHODS
  We identified patients who received recombinant tissue-type plasminogen activator despite recent stroke (within 3 months of acute thrombolysis). Clinical and radiological findings were collected, including early neurological worsening and hemorrhagic transformation on unenhanced computed tomography at 24 hours. Clinical outcome measured by modified Rankin Scale was determined at 3 months from onset.
  
  
  RESULTS
  Six patients presenting with acute stroke within 3 months of previous stroke were identified (median age, 76 years; median National Institutes of Health Stroke Scale, 8.5). Hemorrhagic transformation was seen in the follow-up computed tomography scan in 3 of 6 cases: all were hemorrhagic transformation 1 (petechial hemorrhage), asymptomatic, and mostly located within the area of subacute infarction. There was no early neurological deterioration, and 3 patients had modified Rankin Scale ≤ 2 after 3 months.
  
  
  CONCLUSIONS
  In our center, we thrombolysed 6 patients despite recent stroke. Three patients had asymptomatic petechial hemorrhagic transformation within the area of subacute infarct, without apparent neurological worsening. Prospective studies are needed to explore the possible safety of tissue-type plasminogen activator in the context of previous subacute stroke in otherwise eligible patients.
authors.affiliation: Department of Medicine (Neurology), University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. malhazzaa@ottawahospital.on.ca
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alhazzaa
authors.forename: Mukul
authors.initials: M
authors.lastname: Sharma
authors.forename: Dylan
authors.initials: D
authors.lastname: Blacquiere
authors.forename: Grant
authors.initials: G
authors.lastname: Stotts
authors.forename: Matthew
authors.initials: M
authors.lastname: Hogan
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: outcome; recurrent stroke; sICH; safety; silent stroke; thrombolysis