TPA Safe, Effective for Stroke After Cardiac Cath


NEW ORLEANS — Thrombolysis was safe and effective for treating acute ischemic stroke in patients who recently underwent cardiac catheterization in a review of 48 cases.

Many physicians have been reluctant to use thrombolysis in such patients because of the erroneous presumptions that the intracranial thrombus would not be dissolved by treatment and that postcatheterization patients are especially vulnerable to intracranial hemorrhage. But these concerns were not borne out by this case review, Pooja Khatri, M.D., said while presenting a poster at the 30th International Stroke Conference.

“This is a great population of patients to treat,” said Dr. Khatri, a neurologist at the University of Cincinnati.

Because these patients are still hospitalized when their strokes occur, they can be quickly diagnosed and treated, she explained.

Dr. Khatri and her associates collected case information on 48 consecutive, eligible patients who were treated at several U.S. academic centers since 2001. All patients had an ischemic stroke within 36 hours of cardiac catheterization. Of them, 10 were treated with tissue plasminogen activator (TPA), and the other 38 received only supportive care.

The median National Institutes of Health Stroke Scale (NIHSS) score at the time of diagnosis was 12 in the patients treated with TPA and 6 in those who did not receive thrombolytic therapy. The study's primary outcome was the median improvement in the NIHSS score at 24 hours after initial diagnosis. The median improvement in NIHSS score was 6 points in the patients who got TPA, compared with 0 points in those who did not, a statistically significant difference, reported Dr. Khatri at the conference, which was sponsored by the American Stroke Association.

By 7 days after diagnosis, scores had improved by a median of 6.5 points in those who got TPA and by a median of 2 points in those who did not, also a statistically significant difference.

Substantially better improvement was seen in patients treated with TPA even when the analysis excluded patients with mild strokes, defined as a NIHSS score of 5 or lower at the time of diagnosis. “This will hopefully lead to a substantial change in patient treatment,” she told CARDIOLOGY NEWS.

None of the 48 patients in the study had a symptomatic, intracranial hemorrhage. Six patients had minor, asymptomatic, intracranial hemorrhages, three in the group that received TPA and three in the group that did not get thrombolysis. A total of five patients had minor bleeding at their catheterization puncture sites; one of these patients had received TPA.

None of the patients in either group required a transfusion. No patient had a retroperitoneal hemorrhage, hemopericardium, or other sites of bleeding, Dr. Khatri said.