Thrombolytic-associated coagulopathy and management dilemmas: a review of two cases

Thrombolytic therapy improves the overall outcome of many patients with acute ischemic stroke, but it is associated with complications such as symptomatic intracranial hemorrhage. Several factors predict the risk of hemorrhage. Dramatic changes in the coagulation profile following thrombolytic therapy have not been well studied. However, it is unknown if commonly used laboratory tests for coagulation are of predictive value. Yet these tests are commonly requested to predict or treat symptomatic intracranial hemorrhage. When such tests are abnormal, they may present a management dilemma. In this report, we present two cases of coagulopathy following thrombolytic therapy without symptomatic intracranial hemorrhage that were managed differently. Our report suggests that dramatic changes occur in the coagulation profile of patients who receive thrombolytic therapy, but may not clearly predict symptomatic intracranial hemorrhage. Therefore, other factors should be considered when managing these patients.