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  • 1From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D.S., S.R., S.C., G.S., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (C.H., H.A., C.G., P.A.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.M.Z., T.P.Z., Y.B.R., P.J.N.), Academic Medical Center, Amsterdam, the Netherlands; University Lille (S.M., D.L., C.C.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France; Department of Neurology (O.B., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Stroke Unit (A.Z., L.V.), Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy; Neurology Clinic (V.P., D.R.J.), Clinical Centre of Serbia, Belgrade; Department of Neurology (G.K.), Kantonsspital St. Gallen, Switzerland; Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Institute of Neuroscience and Physiology (T.T.), Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Switzerland. henrik.gensicke@usb.ch.

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Summary

Platelet count affects bleeding risk and outcomes in stroke patients receiving IV thrombolysis (IVT). Lower counts increase hemorrhage risk, while higher counts correlate with mortality, challenging IVT withholding in low platelet counts.

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Area of Science:

  • Neurology
  • Hematology
  • Clinical Trials

Background:

  • Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke.
  • The impact of platelet count (PC) on IVT efficacy and safety requires further elucidation.
  • Current guidelines suggest caution or withholding IVT in patients with low platelet counts.

Purpose of the Study:

  • To investigate the association between platelet count (PC) and the risk of symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in stroke patients treated with IVT.
  • To evaluate the safety and efficacy of withholding IVT in patients with PC below 100 × 109/L.

Main Methods:

  • Prospective, multicenter, register-based study of 7,533 IVT-treated stroke patients.
  • Platelet count analyzed as a continuous and categorical variable (thrombocytopenia, normal, thrombocytosis).
  • Logistic regression models used to calculate adjusted odds ratios (ORs) for sICH, poor outcome, and mortality.

Main Results:

  • Decreasing PC correlated with increased sICH risk (ORadjusted 1.03) but decreased risk of poor outcome and mortality.
  • Thrombocytopenia (PC < 150 × 109/L) increased sICH risk (ORadjusted 1.73), but not significantly poor outcome or mortality.
  • Thrombocytosis (PC > 450 × 109/L) was linked to increased mortality (ORadjusted 2.02).
  • Patients with PC < 100 × 109/L did not show significantly higher risks of sICH, poor outcome, or mortality compared to those with PC ≥ 100 × 109/L.

Conclusions:

  • Platelet count significantly modifies the risk of complications and outcomes following IVT in stroke patients.
  • The findings challenge the routine practice of withholding IVT solely based on a PC < 100 × 109/L threshold.
  • Individualized risk assessment considering PC is crucial for optimizing IVT treatment decisions.