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(Stroke. 2009;40:3635.)
© 2009 American Heart Association, Inc.

Research Letters

Intravenous Tissue Plasminogen Activator in Patients With Cocaine-Associated Acute Ischemic Stroke

Sheryl Martin-Schild, MD, PhD; Karen C. Albright, DO, MPH; Vivek Misra, MD; Maria Philip, MD; Andrew D. Barreto, MD; Hen Hallevi, MD; James C. Grotta, MD Sean I. Savitz, MD

From the Department of Psychiatry & Neurology (S.M.-S.), Tulane University, New Orleans, La; the Department of Neurosciences (K.C.A.), University of California at San Diego, San Diego, Calif; the Department of Neurology (V.M., M.P., A.D.B., J.C.G., S.I.S.), University of Texas Medical School at Houston, Houston, Texas; and the Department of Neurology (H.H.), Tel Aviv Hospital, Tel Aviv, Israel.

Correspondence to Sean I. Savitz, MD, Department of Neurology, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030. E-mail sean.i.savitz{at}uth.tmc.edu

Background and Purpose— The safety of thrombolytic therapy in patients with cocaine-associated acute ischemic stroke (CIS) is unknown.

Methods— We conducted a retrospective review of patients with CIS who presented to our stroke center. Thrombolytic treatment was compared between cocaine-positive (n=29) and cocaine-negative (n=75) patients. We also compared patients with CIS treated with tissue plasminogen activator versus those who did not receive tissue plasminogen activator (n=58). Safety outcomes were determined by the incidence of symptomatic intracerebral hemorrhage, in-hospital mortality, and modified Rankin Scale at hospital discharge.

Results— There were no complications in tissue plasminogen activator-treated patients with CIS. Cocaine-positive and cocaine-negative treated patients had similar stroke severity and safety outcomes. Patients with CIS treated with tissue plasminogen activator had more severe strokes on baseline National Institutes of Health Stroke Scale but similar safety outcomes compared with nontreated patients with CIS.

Conclusion— Thrombolytic therapy for CIS appears to be safe in this small study. Further research is needed to more definitively assess safety and efficacy of tissue plasminogen activator for CIS.

Key Words: acute stroke • cocaine • thrombolysis