Ischemic stroke is caused by sudden occlusion or critical stenosis of a cerebral artery. Alteplase which is an Intravenous Tissue-type Plasminogen activator (IVTPa) is a standard treatment for acute ischemic stroke, but it is contraindicated in coagulation disorders. IVTPa is therefore not used in patients who develop stroke after endovascular procedures which require unfractioned heparin (UFH) administration. We present four cases of acute ischemic stroke patients treated with IVTPa after reversal of UFH induced coagulation deficit with use of protamine sulphate. There were 2 females and 2 males aged 57-81 years, who underwent an endovascular procedure: cryoablation due to atrial fibrillation, percutaneous coronary intervention due to non-ST-segment elevation myocardial infarction or carotid artery angioplasty and stenting in primary stroke prevention. 5.000-10.000 IU UFH was used during each procedure. The patients developed symptoms of acute stroke during or immediately after the procedure. Initial CT scans were normal. Neurological deficit persisted for more than 30 minutes. APTT level was significantly increased therefore 1mg of protamine sulfate on 100 j.m UHF was administered intravenously to reverse anticoagulation. Normalization of APTT was achieved and then 0.9mg/kg alteplase was administered (onset-to-needle time was to 145 -180 minutes). The neurological deficit decreased in all patients and control CT scans showed asymptomatic intracerebral hemorrhage in two patients and ischemic lesion in one patient. IVTPa after protamine sulphate administration in acute stroke patients with increased baseline APTT due to previous use of UHF seems possible, safe and effective.
No datasets are available for this submission.
No license information is available for this submission.