Stroke, Vol 23, 646-652, Copyright © 1992 by American Heart Association
R von Kummer and W Hacke
BACKGROUND AND PURPOSE: There is little reported of the safety and efficacy
of high-dose intravenous recombinant tissue plasminogen activator
(alteplase) in combination with heparin anticoagulation in patients
presenting with acute ischemic stroke. METHODS: Thirty-two patients with
severe hemispheric stroke syndrome caused by angiographically proven middle
cerebral artery and/or intracranial internal carotid artery occlusion were
treated with 100 mg alteplase by intravenous infusion over 90 minutes
within a mean +/- SD of 226 +/- 68 minutes after symptom onset.
Recanalization was assessed by digital subtraction angiography in all
patients immediately after treatment and by transcranial Doppler monitoring
(n = 30) and/or a third angiogram (n = 5) 12-24 hours later. RESULTS:
Complete or partial reperfusion was observed in 11 patients (34%) 90
minutes after the initiation of alteplase infusion and in 17 patients (53%)
within 12-24 hours. Hemorrhagic infarction without clinical deterioration
was detected by follow-up computed tomography in nine patients (28%). Fatal
parenchymal hemorrhage occurred in three patients (9%) with huge middle
cerebral artery infarcts. Serious hemorrhage from the puncture site
occurred in two patients (6%). Good clinical outcome correlated with
reperfusion (p less than 0.05) and the presence of grade 2 collateral blood
flow (p less than 0.01). CONCLUSIONS: When 100 mg of recombinant tissue
plasminogen activator was given within the first 6 hours of acute stroke
together with heparin the incidence of deleterious hemorrhage was less than
10%. Reperfusion and effective collateral blood flow seem to be two
important factors associated with a small infarct volume and good clinical
outcome.
ARTICLES
Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke
Department of Neuroradiology, University of Heidelberg, FRG.
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