title: Usefulness of Thromboelastography in the Detection and Management of Tissue Plasminogen Activator-Associated Hyperfibrinolysis.
abstract: Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT). Here we report a case of ischemic stroke complicated by a remote asymptomatic intracranial hemorrhage after IVT and additional endovascular therapy that has been successfully treated with intravenous infusion of tranexamic acid after the detection of the status of hyperfibrinolysis provided by thromboelastometry. Further studies are needed to provide the potential usefulness of thromboelastometry and tranexamic acid in ischemic stroke complicated by intracranial bleeding.
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rosafio
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Vandelli
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bigliardi
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallieri
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Dell'Acqua
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Picchetto
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy. Electronic address: andrea.zini@me.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zini
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: Hyperfibrinolysis; intracranial hemorrhages; stroke; thromboelastography; thrombolytic therapy