Intravenous thrombolysis and platelet count

Publication

Intravenous thrombolysis and platelet count

Journal Paper/Review - Jan 24, 2018

Gensicke Henrik, Roos Yvo B, Gumbinger Christoph, Jovanovic Dejana R, Curtze Sami, Sibolt Gerli, Vandelli Laura, Ringleb Peter A, Leys Didier, Cordonnier Charlotte, Michel Patrik, Lyrer Philippe A, Peters Nils, Tatlisumak Turgut, Nederkoorn Paul J, Engelter Stefan T, Polymeris Alexandros, Lachenmeier Romina, Al Sultan Abdulaziz S, Strbian Daniel, Hametner Christian, Zinkstok Sanne M, Moulin Solène, Bill Olivier, Zini Andrea, Padjen Visnja, Kägi Georg, Pezzini Alessandro, Seiffge David J, Traenka Christopher, Räty Silja, Amiri Hemasse, Zonneveld Thomas P, Thrombolysis in Stroke Patients (TRISP) Collaborators

Citation

Gensicke H, Roos Y, Gumbinger C, Jovanovic D, Curtze S, Sibolt G, Vandelli L, Ringleb P, Leys D, Cordonnier C, Michel P, Lyrer P, Peters N, Tatlisumak T, Nederkoorn P, Engelter S, Polymeris A, Lachenmeier R, Al Sultan A, Strbian D, Hametner C, Zinkstok S, Moulin S, Bill O, Zini A, Padjen V, Kägi G, Pezzini A, Seiffge D, Traenka C, Räty S, Amiri H, Zonneveld T, Thrombolysis in Stroke Patients (TRISP) Collaborators. Intravenous thrombolysis and platelet count. Neurology 2018; 90:e690-e697.

Type

Journal Paper/Review (English)

Journal

Neurology 2018; 90

Publication Date

Jan 24, 2018

Issn Electronic

1526-632X

Pages

e690-e697

Brief description/objective

OBJECTIVE
To study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 10/L is supported.

METHODS
In this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 × 10/L), thrombocytosis (>450 × 10/L), and normal PC (150-450 × 10/L [reference group]). Moreover, PC < 100 × 10/L was compared to PC ≥ 100 × 10/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated.

RESULTS
Among 7,533 IVT-treated stroke patients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 × 10/L) was associated with increasing risk of sICH (OR1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (OR0.99, 95% CI 0.98-0.99) and mortality (OR0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (OR1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (OR0.89, 95% CI 0.39-1.97) and mortality (OR1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (OR2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 10/L. Their risks of sICH (OR1.56, 95% CI 0.48-5.07), poor outcome (OR1.63, 95% CI 0.82-3.24), and mortality (OR1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC ≥ 100 × 10/L.

CONCLUSION
Lower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 10/L is challenged.