Thromboelastographic changes in patients experiencing an acute ischemic stroke and receiving alteplase.
BACKGROUND
Thromboelastography is a method of measuring whole-blood coagulation changes and has been used to guide therapy and monitor changes in a variety of disease states. However, few studies have investigated the thromboelastographic changes experienced in a patient who has received alteplase for an acute ischemic stroke. This pilot study sought to describe the effect of alteplase on the thromboelastogram tracings of patients experiencing an acute ischemic stroke.


METHODS
This was an institutional review board-approved prospective cohort study. Patients who presented to the emergency department with symptoms of acute ischemic stroke and received intravenous alteplase were evaluated for inclusion. Blood samples were obtained before alteplase administration and at 30, 60, 90, 120, and 150 minutes after alteplase administration. In addition, baseline variables collected included patient age, sex, prothrombin time, partial thromboplastin time, and the use of pretreatment anticoagulants or antiplatelet agents. Patients were also followed throughout their hospital stay for development of intracranial hemorrhage.


RESULTS
A total of 7 patients were included in the analysis. At baseline, thromboelastogram parameters of all patients were within the normal range. The maximum inhibition of fibrin buildup was seen at 30 minutes after the start of alteplase infusion, and the lowest clot strength was observed at 60 minutes after initiation of alteplase. Most patients return to near baseline parameters within 150 minutes of alteplase initiation; however, 2 patients did not return to their baseline values within the 150-minute time frame.


CONCLUSIONS
Our study suggests that thromboelastogram (TEG) is a useful tool for determining changes in the coagulation system of patients whom have received recombinant tissue plasminogen activator (rt-PA). Further study is needed to determine if TEG can be used to predict those patients who may be at higher risk of adverse events because of rt-PA.
Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Knoxville, Tennessee. Electronic address: arowe@uthsc.edu.
A Shaun
AS
Rowe
Department of Anesthesiology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee.
Christal L
CL
Greene
Department of Anesthesiology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee.
Carolyn C
CC
Snider
Department of Anesthesiology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee.
Roger C
RC
Carroll
Cole Neuroscience Center, Knoxville, Tennessee.
Brian F
BF
Wiseman
Brain and Spine Institute, The University of Tennessee Medical Center, Knoxville, Tennessee.
Jennifer M
JM
Henry
Department of Anesthesiology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee.
J Russell
JR
Langdon
Department of Anesthesiology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee.
Robert M
RM
Craft
D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects*; D002545:Brain Ischemia / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000188:drug therapy; D013916:Thrombelastography; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Ischemic stroke; alteplase; fibrinolysis; thromboelasetography