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(Stroke. 2007;38:1639.)
© 2007 American Heart Association, Inc.

Research Reports

Usefulness of Checking Platelet Count Before Thrombolysis in Acute Ischemic Stroke

Brett L. Cucchiara, MD; Bryon Jackson, MD; Mark Weiner, MD Steven R. Messe, MD

From the Departments of Neurology (B.L.C., B.J., S.R.M.) and Medicine (M.W.), University of Pennsylvania Medical Center, Philadelphia, Pa.

Correspondence to Brett L. Cucchiara, MD, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. E-mail cucchiar{at}mail.med.upenn.edu

Background and Purpose— Thrombolysis for acute ischemic stroke is strikingly time sensitive. Current guidelines require confirmation of a platelet count 100 000 before thrombolysis; however, obtaining this laboratory test may delay treatment.

Methods— We queried our hospital database to identify patients with ICD-9 codes consistent with acute ischemic stroke from 2000 to 2005 and to determine platelet counts in these patients. Medical charts of patients with platelet counts <100 000 were reviewed to determine whether the patient had a known history of thrombocytopenia or conditions associated with thrombocytopenia.

Results— A total of 1752 patients were identified, and 82 (4.7%) had a platelet count <100 000 at stroke onset. Only 6/1752 (0.3%) had a platelet count <100 000 which was not suspected based on initial history. All of these 6 patients had only mildly decreased platelet counts.

Conclusions— An unsuspected platelet count <100 000 was found in 0.3% of patients at stroke presentation. In patients without a history of thrombocytopenia or predisposing factors, the benefit of earlier thrombolysis may outweigh the bleeding risk of inadvertently treating a patient with thrombocytopenia.

Key Words: platelet count • stroke • thrombolysis