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Usefulness of Thromboelastography in the Detection and Management of Tissue Plasminogen Activator-Associated

Francesca Rosafio1, Laura Vandelli1, Guido Bigliardi1

  • 1Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, NOCSAE, AUSL Modena, Baggiovara, Modena, Italy.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|November 28, 2016
PubMed

Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT). Here we report a case of ischemic stroke complicated by a remote asymptomatic intracranial hemorrhage after IVT and additional endovascular therapy that has been successfully treated with intravenous infusion of tranexamic acid after the detection of the status of hyperfibrinolysis provided by thromboelastometry. Further studies are needed to provide the potential usefulness of thromboelastometry and tranexamic acid in ischemic stroke complicated by intracranial bleeding.

Keywords:
Hyperfibrinolysisintracranial hemorrhagesstrokethromboelastographythrombolytic therapy

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