title: Aortic transgraft hemorrhage after intravenous tissue plasminogen activator therapy in patients with acute ischemic stroke.
abstract: BACKGROUND
  The safety of intravenous recombinant tissue plasminogen activator (IV tPA) therapy for patients with an aortic aneurysm or undergoing aortic graft replacement has not been established. We evaluated the incidence, bleeding site, coagulation factors, and clinical outcomes of patients treated with IV tPA for acute stroke.
  
  
  METHODS
  Between October 2005 and May 2013, 394 ischemic stroke patients were treated in our stroke center with IV tPA. Among these patients, we investigated those who had a history of aortic aneurysm with or without aortic graft replacement before IV tPA therapy and underwent computed tomography imaging. We compared the levels of D-dimer and hemoglobin (Hb) around IV tPA therapy between the patients with and without tPA-associated periaortic bleeding.
  
  
  RESULTS
  Seven patients with a history of aortic aneurysm (3 men; mean age: 80.4 years) were examined; 3 had undergone aortic graft replacement, and 2 had experienced tPA-associated bleeding around vascular grafts. The serum D-dimer levels in those with bleeding were only slightly higher before tPA than in those without (median: 10.5 vs. 1.5 μg/mL) but were elevated 1 day after tPA (107.4 vs. 8.6 μg/mL). The Hb levels 2 days after tPA were comparable with those before tPA (11.9 vs. 11.8 g/dL) but were lower in the patients with bleeding than in those without (8.5 vs. 11.7 g/dL). Surgical intervention was not required, although 1 patient required blood transfusion.
  
  
  CONCLUSIONS
  Our analysis provides reassurance regarding the risk of IV tPA therapy in patients undergoing aortic graft replacement.
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: kawano@neurol.med.osaka-u.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Higashi
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Minatoya
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery; D001779:Blood Coagulation Factors / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D058017:Vascular Grafting / Q000379:methods*
chemical_list: D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; D010959:Tissue Plasminogen Activator
keywords: IV tPA therapy; Intravenous thrombolysis; acute ischemic stroke; aortic aneurysm; aortic graft replacement; aortic transgraft hemorrhage