title: Acute ischemic stroke after cardiac catheterization: the protamine low-dose recombinant tissue plasminogen activator pathway.
abstract: : Intravenous thrombolysis is the preferred treatment for acute ischemic stroke; however, it remains unestablished in the area of cardiac catheterization. We report three patients with acute ischemic stroke after cardiac catheterization. After reversing the anticoagulant effect of unfractionated heparin with protamine, all of the patients were successfully off-label thrombolyzed with reduced doses of intravenous recombinant tissue plasminogen activator (0.6 mg/kg). This dose was preferred to reduce the risk of symptomatic cerebral or systemic bleeding. The sequential pathway of protamine recombinant tissue plasminogen activator at reduced doses may be safer for reducing intracranial or systemic bleeding events, whereas remaining efficacious for the treatment of acute ischemic stroke after cardiac catheterization.
authors.affiliation: aFacultad de Medicina, Universidad de Chile, Santiago bFacultad de Medicina, Universidad de Valparaiso, Valparaiso cUnidad de Hematologia dUnidad de Cardiologia, Universidad de Chile, Santiago, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Guevara
authors.forename: Alonso
authors.initials: A
authors.lastname: Quijada
authors.forename: Carolina
authors.initials: C
authors.lastname: Rosas
authors.forename: Katya
authors.initials: K
authors.lastname: Bulatova
authors.forename: Hugo
authors.initials: H
authors.lastname: Lara
authors.forename: Elena
authors.initials: E
authors.lastname: Nieto
authors.forename: Marcelo
authors.initials: M
authors.lastname: Morales
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011479:Protamines / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy / Q000209:etiology*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006494:Heparin Antagonists; D011479:Protamines; D010959:Tissue Plasminogen Activator