Thromboelastographic changes in patients experiencing an acute ischemic stroke and receiving alteplase

Area of Science:

• Neurology
• Hematology
• Pharmacology

Background:

• Thromboelastography (TEG) assesses whole-blood coagulation and guides therapy.
• Few studies have examined TEG changes after alteplase (rt-PA) for acute ischemic stroke.
• This pilot study describes TEG alterations in patients receiving rt-PA.

Purpose of the Study:

• To describe the effect of alteplase on thromboelastogram tracings.
• To evaluate TEG as a tool for monitoring coagulation changes post-rt-PA.
• To explore the potential of TEG in predicting adverse events.

Main Methods:

• Prospective cohort study of 7 patients with acute ischemic stroke receiving IV alteplase.
• Blood samples collected at baseline and at 30, 60, 90, 120, and 150 minutes post-alteplase.
• Baseline variables included demographics, PT, PTT, and use of anticoagulants/antiplatelet agents; intracranial hemorrhage was monitored.

Main Results:

• Baseline TEG parameters were within normal limits for all patients.
• Maximum inhibition of fibrin buildup occurred at 30 minutes post-alteplase.
• Lowest clot strength was observed at 60 minutes; most patients normalized by 150 minutes, but 2 did not.

Conclusions:

• Thromboelastography (TEG) effectively measures coagulation system changes in patients treated with alteplase (rt-PA).
• Further research is needed to determine if TEG can predict adverse events associated with rt-PA therapy.