title: Intravenous thrombolysis in a patient taking warfarin with an international normalised ratio of 1.9.
abstract: Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has strict eligibility criteria. Symptomatic intracranial haemorrhage (sICH) is the most adverse complication. A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome. This is the first fully documented case report of the contraindicated use of intravenous thrombolysis in a patient presenting with an acute ischaemic stroke on a background of concurrent use of warfarin with an international normalised ratio (INR) as high as 1.9. It has been perceived that the risk of thrombolysis with a raised INR outweighs the potential benefits. However, documenting its use outside of the current eligibility criteria is key to future developments.
authors: West Hertfordshire Hospitals NHS Trust, Hemel Hempstead, Hertfordshire, UK.
authors: Joanna
authors: http://orcid.org/0000-0002-3746-6942
authors: J
authors: Kefas
authors: Stroke Unit, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead, Hertfordshire, UK.
authors: Mohit
authors: M
authors: Bhandari
authors: West Hertfordshire Hospitals NHS Trust, Hemel Hempstead, Hertfordshire, UK.
authors: Naman
authors: N
authors: Bhatt
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008279:Magnetic Resonance Imaging; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin