Abstract
Background
Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised
about the risk of hemorrhage in patients having received warfarin. Therefore, different
indications for thrombolytic treatment are in use for stroke patients on warfarin.
However, it remains uncertain whether the prior warfarin use actually increases their
risk of bleeding in patients treated with thrombolysis.
Methods
This study included 179 consecutive patients who had high-risk cardioembolic sources
and received thrombolytic treatment. Patients were treated with intravenous thrombolytic
agents, or underwent intraarterial thrombolysis if their international normalized
ratio (INR) was ≤1.7. We compared the frequency of bleeding complications between patients with prior
warfarin use and those without. We also investigated whether there were differences
in functional outcome and recanalization rates between them.
Results
A prior warfarin use was present in 28 patients (15.6%). Although INR levels were
higher in the prior warfarin group, the frequency of bleeding complications was not
different between patients who received prior warfarin and those who did not. No differences
were observed in patients with or without prior warfarin use, for successful recanalization
rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified
Rankin score (≤2) at 3 months.
Conclusions
Thrombolytic therapy for patients who previously received warfarin and had an INR≤1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data
suggest that patients with a history of prior warfarin use may be safely treated with
thrombolytic agents when their INR levels are low.
Keywords
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Article info
Publication history
Published online: August 27, 2010
Accepted:
July 29,
2010
Received in revised form:
July 26,
2010
Received:
February 18,
2010
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
