title: Clotting factors to treat thrombolysis-related symptomatic intracranial hemorrhage in acute ischemic stroke.
abstract: BACKGROUND
  Symptomatic intracranial hemorrhage (sICH) occurs uncommonly after ischemic stroke therapy with tissue plasminogen activator (tPA). Clotting factor administration may be a treatment option.
  
  
  OBJECTIVE
  To determine if treatment with clotting factors (fresh frozen plasma [FFP] or cryoprecipitate) was associated with improved outcomes in sICH.
  
  
  METHODS
  We conducted a retrospective cohort study within University of Texas at Houston Stroke registry involving consecutive patients from February 1, 2007, to June 30, 2011, with tPA-related sICH, including cases with subsequent intra-arterial therapy. Outcomes were Modified Rankin Scale (mRS) score at discharge, death, and hematoma expansion.
  
  
  RESULTS
  Of 921 patients treated with tPA, 48 (5.2%) had sICH and 45 met criteria for the study. Nineteen patients received clotting factors (42.2%; 18 received FFP and 7 received cryoprecipitate), whereas 26 (57.8%) patients received conservative management without clotting factors. None of the patients treated with clotting factors and only 2 of those who did not receive clotting factors had a good outcome, mRS score of 2 or less. All the patients treated with clotting factors and most of those not treated were left bedridden or dead (mRS score 4-6), 19 (100%) versus 22 (85%). Mortality was 9 (47.4%) versus 9 (34.6%), respectively. There was no difference in hematoma expansion between the 2 groups.
  
  
  CONCLUSIONS
  We found no evidence that treatment for sICH with clotting factors has a favorable effect on clinical or radiological outcomes. However, the sample was small because of the low frequency of sICH. New treatments are urgently needed for this uncommon yet serious condition.
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: yazanalderazi@yahoo.com.
authors: Yazan J
authors: YJ
authors: Alderazi
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Niravkumar V
authors: NV
authors: Barot
authors: Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Hui
authors: H
authors: Peng
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Farhaan S
authors: FS
authors: Vahidy
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Digvijaya D
authors: DD
authors: Navalkele
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Navdeep
authors: N
authors: Sangha
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Vivek
authors: V
authors: Misra
authors: Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas.
authors: Sean I
authors: SI
authors: Savitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects*; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D003029:Coagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013781:Texas; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Cerebrovascular disease; acute ischemic stroke; fresh frozen plasma; stroke; symptomatic intracranial hemorrhage; thrombolysis