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Acute ischemic stroke after cardiac catheterization: the protamine low-dose recombinant tissue plasminogen activator

Carlos Guevara1, Alonso Quijada, Carolina Rosas

  • 1aFacultad de Medicina, Universidad de Chile, Santiago bFacultad de Medicina, Universidad de Valparaiso, Valparaiso cUnidad de Hematologia dUnidad de Cardiologia, Universidad de Chile, Santiago, Chile.

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|May 24, 2016
PubMed

Insights

Intravenous thrombolysis for acute ischemic stroke after cardiac catheterization is challenging. A novel approach using protamine followed by reduced-dose recombinant tissue plasminogen activator shows promise for safe and effective treatment.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Intravenous thrombolysis is the gold standard for acute ischemic stroke.
  • Its use after cardiac catheterization is not established due to bleeding risks associated with anticoagulation.

Observation:

  • Three patients experienced acute ischemic stroke following cardiac catheterization.
  • These patients had received unfractionated heparin, requiring reversal with protamine.

Findings:

  • Off-label thrombolysis was successfully administered using reduced doses (0.6 mg/kg) of recombinant tissue plasminogen activator.
  • This sequential protamine-recombinant tissue plasminogen activator strategy aimed to minimize bleeding risks.

Implications:

  • This approach may offer a safer alternative for treating acute ischemic stroke post-cardiac catheterization.
  • Further research is warranted to validate the efficacy and safety of this reduced-dose thrombolysis protocol.

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