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Thrombolysis Following Heparin Reversal With Protamine Sulfate in Acute Ischemic Stroke: Case Series and Literature Review.

Authors
  • Ranasinghe, Tamra1
  • Mays, Traci2
  • Quedado, Jeff3
  • Adcock, Amelia4
  • 1 Department of Neurology, West Virginia University, Morgantown, West Virginia. Electronic address: [email protected]
  • 2 Health Science Library, West Virginia University, Morgantown, West Virginia.
  • 3 Department of Pharmacy, West Virginia University, Morgantown, West Virginia.
  • 4 Department of Neurology, West Virginia University, Morgantown, West Virginia.
Type
Published Article
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
Publication Date
Oct 01, 2019
Volume
28
Issue
10
Pages
104283–104283
Identifiers
DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.041
PMID: 31324409
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Administering intravenous IV tissue plasminogen activator (tPA) is the recommended standard of care in acute ischemic stroke (AIS), although it is not recommended to administer intravenous thrombolysis with tPA following heparin reversal with protamine sulfate in patients with AIS. We describe a case series of three patients and the most comprehensive literature review published to date in this specific subset of AIS patients undergoing thrombolysis following heparin reversal with protamine sulfate. The literature review was based on a scoping review methodology performed on four databases; PubMed, CINAHL, Web of Science, and Cochrane Library. All sources were searched from the inauguration of the database until February 2019. A total of six articles involving eight patients were identified. The primary safety outcome of no symptomatic intracranial hemorrhage (sICH) was met in all eleven patients, although only seven cases had a good functional outcome at 3 months. In appropriately selected AIS patients, coagulopathy correction appears to be safe from an sICH standpoint and may be beneficial. However, given the potential for bias with observational databases, case reports and case series, extreme caution is warranted in applying these results to routine clinical practice. Copyright © 2019 Elsevier Inc. All rights reserved.

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