title: Successful intravenous thrombolysis in a patient with antiphospholipid syndrome, acute ischemic stroke and severe thrombocytopenia.
abstract: Alteplase is the only approved drug for the treatment of acute ischemic stroke, but it is offered to a minority of patients, not only because of the short therapeutic window but also because of the numerous contraindications associated with thrombolysis, such as thrombocytopenia. There is some controversy on the true risk associated with thrombolysis in patients with thrombocytopenia. Here we report the case of a young patient, who developed an in-hospital acute ischemic stroke involving a large territory of the right middle cerebral artery, who was successfully treated with intravenous alteplase, despite having thrombocytopenia and prolonged prothrombin times due to systemic lupus erythematosus and antiphospholipid syndrome. This case exemplifies the need to reassess contraindications for thrombolysis, many based on expert opinion and not clinical evidence, especially in complex clinical situations.
authors.affiliation: aServicio de Neurologia bDepartamento de Medicina Interna, Hospital Universitario "Dr José E. González" yFacultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Camara-Lemarroy
authors.forename: Adrian
authors.initials: A
authors.lastname: Infante-Valenzuela
authors.forename: Catalina J
authors.initials: CJ
authors.lastname: Andrade-Vazquez
authors.forename: Raul V
authors.initials: RV
authors.lastname: Enriquez-Noyola
authors.forename: Erick A
authors.initials: EA
authors.lastname: Garcia-Valadez
authors.forename: Fernando
authors.initials: F
authors.lastname: Gongora-Rivera
mesh_terms: D016736:Antiphospholipid Syndrome / Q000150:complications*; D001921:Brain / Q000098:blood supply; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000150:complications*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator