Abstract Details

Title Acute thrombocytopenia after tissue plasminogen activator for stroke: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-012

Objective Acute thrombocytopenia has not been reported following tissue plasminogen activator (tPA) for acute ischemic stroke.

Background Transient coagulopathy with decreased fibrinogen after tPA is well described. Acute thrombocytopenia has been reported with combination thrombolytics and antiplatelet agents for myocardial infarction.

Design/Methods An 88-year-old right-handed female with a history of atrial fibrillation developed acute left sided weakness, forced rightward gaze deviation, and neglect. She received a standard dose of tPA. She was found to have right internal carotid artery and proximal right middle cerebral artery occlusions and underwent emergent thrombectomy with successful TICI IIb revascularization. Her platelet count was 146 K/uL on admission and her INR was 1.2 five hours after tPA was given. Ten hours after tPA was administered, her platelet count decreased to 15 K/uL and her fibrinogen was 149 mg/dL. Thrombocytopenia was confirmed on repeat evaluation. She was transfused two units of platelets. Fourteen hours after tPA her fibrinogen had improved to 249 mg/dL and sixteen hours after tPA her platelet count improved to 222 K/uL. She was noted to have scattered ecchymosis and petechial hemorrhages the day after tPA was given. She underwent extensive workup for heparin induced thrombocytopenia and disseminated intravascular coagulation, which was unremarkable. The patient had no history of alcohol abuse or liver disease and her liver enzymes were normal. She had no known history of thrombocytopenia. The hematology team felt her thrombocytopenia was secondary to transient coagulopathy after tPA.

Results NA

Conclusions This is the first case report of acute thrombocytopenia after tPA for acute ischemic stroke. The bleeding and mortality risk associated with thrombocytopenia after tPA is unknown.

Authors/Disclosures
Jonathan Morena, DO (Duke, Neurology) PRESENTER	Dr. Morena has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acumetis. Dr. Morena has received personal compensation in the range of $0-$499 for serving as a Consultant for Optio Biopharma Solutions. Dr. Morena has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Morena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Morena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Johnson & Johnson. The institution of Dr. Morena has received research support from Grifols.
	No disclosure on file
Tamara Strohm, MD	Dr. Strohm has nothing to disclose.

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