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Thrombolysis in Postoperative Stroke.

Nicolas Voelkel1, Nikolai Dominik Hubert2, Roland Backhaus2

  • 1From the Department of Neurology, TEMPiS Telemedical Stroke Center, Staedtisches Klinikum Muenchen, Munich, Germany (N.V., N.D.H., L.H., G.J.H.); and Department of Neurology, University of Regensburg, Germany (R.B.). nicolas.voelkel@klinikum-muenchen.de.

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|September 24, 2017
PubMed
Summary

Intravenous thrombolysis (IVT) for acute ischemic stroke is safe in postoperative patients. However, recent surgery increases surgical site hemorrhage risk, requiring careful risk-benefit assessment before treatment.

Keywords:
general surgeryhemorrhagesafetystroketissue-type plasminogen activator

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Thrombolytic Therapy

Background:

  • Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke.
  • Recent surgery is a known contraindication for IVT due to bleeding risks.
  • The safety of IVT in patients with a history of recent surgery requires further investigation.

Purpose of the Study:

  • To evaluate the safety of intravenous thrombolysis (IVT) in patients who have undergone recent surgery.
  • To analyze the incidence of surgical site hemorrhage following IVT in postoperative stroke patients.

Main Methods:

  • Retrospective analysis of 4848 patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (2003-2014).
  • Identified 134 patients who had surgery within 90 days before stroke and received IVT.
  • Assessed surgical site hemorrhage as the primary outcome, comparing recent (1-10 days) vs. nonrecent (11-90 days) and major vs. minor surgeries.

Main Results:

  • Nine patients (7%) experienced surgical site hemorrhage, with 4 (3%) being serious but non-fatal.
  • Recent surgery (1-10 days prior) was associated with a significantly higher risk of surgical site hemorrhage (14.3% vs. 2.4%).
  • Major surgery showed a trend towards higher hemorrhage risk compared to minor surgery (8.1% vs. 4.2%).

Conclusions:

  • Intravenous thrombolysis can be safely administered to postoperative stroke patients after careful risk-benefit evaluation.
  • Particular caution is advised for patients who underwent surgery shortly before stroke onset due to elevated bleeding risks.
  • Off-label use of IVT in this population necessitates individualized treatment decisions.