Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

Young Dae Kim, Jung Hwan Lee, Yo Han Jung, Hye Yeon Choi, Chung Mo Nam, Jae Hoon Yang, Han Jin Cho, Hyo Suk Nam, Kyung Yul Lee, Jihoe Heo

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised about the risk of hemorrhage in patients having received warfarin. Therefore, different indications for thrombolytic treatment are in use for stroke patients on warfarin. However, it remains uncertain whether the prior warfarin use actually increases their risk of bleeding in patients treated with thrombolysis. Methods: This study included 179 consecutive patients who had high-risk cardioembolic sources and received thrombolytic treatment. Patients were treated with intravenous thrombolytic agents, or underwent intraarterial thrombolysis if their international normalized ratio (INR) was ≤ 1.7. We compared the frequency of bleeding complications between patients with prior warfarin use and those without. We also investigated whether there were differences in functional outcome and recanalization rates between them. Results: A prior warfarin use was present in 28 patients (15.6%). Although INR levels were higher in the prior warfarin group, the frequency of bleeding complications was not different between patients who received prior warfarin and those who did not. No differences were observed in patients with or without prior warfarin use, for successful recanalization rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified Rankin score (≤ 2) at 3 months. Conclusions: Thrombolytic therapy for patients who previously received warfarin and had an INR ≤ 1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data suggest that patients with a history of prior warfarin use may be safely treated with thrombolytic agents when their INR levels are low.

Original languageEnglish
Pages (from-to)101-105
Number of pages5
JournalJournal of the Neurological Sciences
Volume298
Issue number1-2
DOIs
Publication statusPublished - 2010 Nov 15

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Warfarin
Stroke
Safety
International Normalized Ratio
Hemorrhage
Therapeutics
Fibrinolytic Agents
Thrombolytic Therapy
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Kim, Young Dae ; Lee, Jung Hwan ; Jung, Yo Han ; Choi, Hye Yeon ; Nam, Chung Mo ; Yang, Jae Hoon ; Cho, Han Jin ; Nam, Hyo Suk ; Lee, Kyung Yul ; Heo, Jihoe. / Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use. In: Journal of the Neurological Sciences. 2010 ; Vol. 298, No. 1-2. pp. 101-105.
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abstract = "Background: Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised about the risk of hemorrhage in patients having received warfarin. Therefore, different indications for thrombolytic treatment are in use for stroke patients on warfarin. However, it remains uncertain whether the prior warfarin use actually increases their risk of bleeding in patients treated with thrombolysis. Methods: This study included 179 consecutive patients who had high-risk cardioembolic sources and received thrombolytic treatment. Patients were treated with intravenous thrombolytic agents, or underwent intraarterial thrombolysis if their international normalized ratio (INR) was ≤ 1.7. We compared the frequency of bleeding complications between patients with prior warfarin use and those without. We also investigated whether there were differences in functional outcome and recanalization rates between them. Results: A prior warfarin use was present in 28 patients (15.6{\%}). Although INR levels were higher in the prior warfarin group, the frequency of bleeding complications was not different between patients who received prior warfarin and those who did not. No differences were observed in patients with or without prior warfarin use, for successful recanalization rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified Rankin score (≤ 2) at 3 months. Conclusions: Thrombolytic therapy for patients who previously received warfarin and had an INR ≤ 1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data suggest that patients with a history of prior warfarin use may be safely treated with thrombolytic agents when their INR levels are low.",
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Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use. / Kim, Young Dae; Lee, Jung Hwan; Jung, Yo Han; Choi, Hye Yeon; Nam, Chung Mo; Yang, Jae Hoon; Cho, Han Jin; Nam, Hyo Suk; Lee, Kyung Yul; Heo, Jihoe.

In: Journal of the Neurological Sciences, Vol. 298, No. 1-2, 15.11.2010, p. 101-105.

Research output: Contribution to journalArticle

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T1 - Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

AU - Kim, Young Dae

AU - Lee, Jung Hwan

AU - Jung, Yo Han

AU - Choi, Hye Yeon

AU - Nam, Chung Mo

AU - Yang, Jae Hoon

AU - Cho, Han Jin

AU - Nam, Hyo Suk

AU - Lee, Kyung Yul

AU - Heo, Jihoe

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N2 - Background: Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised about the risk of hemorrhage in patients having received warfarin. Therefore, different indications for thrombolytic treatment are in use for stroke patients on warfarin. However, it remains uncertain whether the prior warfarin use actually increases their risk of bleeding in patients treated with thrombolysis. Methods: This study included 179 consecutive patients who had high-risk cardioembolic sources and received thrombolytic treatment. Patients were treated with intravenous thrombolytic agents, or underwent intraarterial thrombolysis if their international normalized ratio (INR) was ≤ 1.7. We compared the frequency of bleeding complications between patients with prior warfarin use and those without. We also investigated whether there were differences in functional outcome and recanalization rates between them. Results: A prior warfarin use was present in 28 patients (15.6%). Although INR levels were higher in the prior warfarin group, the frequency of bleeding complications was not different between patients who received prior warfarin and those who did not. No differences were observed in patients with or without prior warfarin use, for successful recanalization rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified Rankin score (≤ 2) at 3 months. Conclusions: Thrombolytic therapy for patients who previously received warfarin and had an INR ≤ 1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data suggest that patients with a history of prior warfarin use may be safely treated with thrombolytic agents when their INR levels are low.

AB - Background: Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised about the risk of hemorrhage in patients having received warfarin. Therefore, different indications for thrombolytic treatment are in use for stroke patients on warfarin. However, it remains uncertain whether the prior warfarin use actually increases their risk of bleeding in patients treated with thrombolysis. Methods: This study included 179 consecutive patients who had high-risk cardioembolic sources and received thrombolytic treatment. Patients were treated with intravenous thrombolytic agents, or underwent intraarterial thrombolysis if their international normalized ratio (INR) was ≤ 1.7. We compared the frequency of bleeding complications between patients with prior warfarin use and those without. We also investigated whether there were differences in functional outcome and recanalization rates between them. Results: A prior warfarin use was present in 28 patients (15.6%). Although INR levels were higher in the prior warfarin group, the frequency of bleeding complications was not different between patients who received prior warfarin and those who did not. No differences were observed in patients with or without prior warfarin use, for successful recanalization rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified Rankin score (≤ 2) at 3 months. Conclusions: Thrombolytic therapy for patients who previously received warfarin and had an INR ≤ 1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data suggest that patients with a history of prior warfarin use may be safely treated with thrombolytic agents when their INR levels are low.

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