Published Online
on December 21, 2006

A more recent version of this article appeared on February 1, 2007

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Submitted on September 11, 2006
Accepted on September 21, 2006

Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke

Aitziber Aleu MD^*; Patricio Mellado MD; Christoph Lichy MD; Martin Köhrmann MD; and Peter D. Schellinger MD, PhD

From the Neurointensive Care Unit, Department of Neurology (A.A., P.M., C.L., M.K., P.D.S.), University of Heidelberg, Heidelberg, Germany; Universitat Autònoma de Barcelona (A.A.), Barcelona, Spain; the Departamento de Neurología (P.M.), Pontificia Universidad Católica, Santiago, Chile; and the Department of Neurology (P.D.S.), University of Erlangen, Erlangen, Germany.

^* To whom correspondence should be addressed. E-mail: aitziberaleu{at}gmail.com.

Background and Purpose--Only 2% to 4% of patients with acute ischemic stroke receive thrombolytic therapy resulting from the current strict inclusion criteria among other issues. Safety of intravenous and intraarterial thrombolysis in off-label situations is controversially discussed. We sought to review the reports on such patients regarding intra- and extracranial hemorrhage.

Summary of Review--A MEDLINE search for off-label uses of thrombolysis revealed reports on 273 patients treated with intraarterial or intravenous thrombolysis for ischemic stroke. Symptomatic intracranial hemorrhage occurred in 19 of 273 patients (6.95%) and extracranial hemorrhage in 17 of 273 (6.22%).

Conclusions--These data suggest that the overall bleeding risk in off-label thrombolysis may not be as high as presumed. However, the small number of patients in each group and the likely underreporting of worse outcomes preclude drawing any conclusion as to specific treatment recommendations. Selected patients might benefit, however, from thrombolysis in situations not currently considered in the inclusion criteria. To obtain a meaningful database, a registry for off-label thrombolysis should be created.

Key words: safety • symptomatic intracranial hemorrhage • thrombolysis

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