title: Waiting for platelet counts causes unsubstantiated delay of thrombolysis therapy.
abstract: BACKGROUND
  Platelet counts (PCs) <100,000/µl are considered as a contraindication for intravenous thrombolysis (IVT). While US guidelines recommend IVT initiation before the availability of clotting tests, the guidelines of the European Stroke Organization give no such practical advice. We aimed to assess the incidence of thrombocytopenia in IVT patients, outcome after thrombolysis in affected patients and the time gained by initiating treatment prior to availability of PC results.
  
  
  METHODS
  All patients with thrombocytopenia were identified in our prospectively acquired thrombolysis database. Baseline demographic data, intracerebral hemorrhage rates as well as functional outcome were assessed. The median time between initiation of thrombolysis and availability of PCs was calculated.
  
  
  RESULTS
  Of 625 IVT patients, 3 (0.5%) had thrombocytopenia at stroke onset. None of them developed intracerebral hemorrhage (ICH) or died during the follow-up. Waiting for PCs would have delayed treatment in 72.4% of the patients, with a median hypothetical delay of 22 min (interquartile range: 11-41 min).
  
  
  CONCLUSIONS
  To date, there are no sufficient data to evaluate the ICH risk in thrombocytopenic patients. However, thrombocytopenia is rare in IVT patients. Thus, generally waiting for PC results prior to initiation of IVT is not warranted. Avoiding this significant delay yields shorter door-to-needle times and potentially more effective treatment.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany. lorenz.breuer@uk-erlangen.de
authors.forename: L
authors.initials: L
authors.lastname: Breuer
authors.forename: H B
authors.initials: HB
authors.lastname: Huttner
authors.forename: I C
authors.initials: IC
authors.lastname: Kiphuth
authors.forename: J
authors.initials: J
authors.lastname: Ringwald
authors.forename: M J
authors.initials: MJ
authors.lastname: Hilz
authors.forename: S
authors.initials: S
authors.lastname: Schwab
authors.forename: M
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors