Repeated thrombolysis for chronologically separated ischemic strokes: a case series

Recombinant tissue plasminogen activator is used for the treatment of acute myocardial infarction, pulmonary embolism, and acute ischemic stroke. With many years since approval of the drug and an aging population, chances increase that patients are treated twice for chronologically separated events.

We identified patients from the prospective Erlangen Stroke and Thrombolysis Database who received repeated thrombolysis for acute ischemic stroke. Baseline demographic data and clinical, laboratory, and imaging findings were analyzed. Functional outcome was assessed after 3 months.

Eight patients treated twice and one patient with 3 treatments were identified. The median time span between first and second thrombolysis was 10 (3 to 48) months. All patients had a favorable outcome after the first treatment, and 67% of patients had a favorable outcome after the second thrombolysis. Neither allergic reactions nor other immunoreactive events were observed.

Repeated administration of recombinant tissue plasminogen activator for chronologically separate ischemic strokes does not appear to be associated with severe immune reactions. Larger case numbers are needed to evaluate safety and efficacy of repeated systemic thrombolysis.