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(Stroke. 2004;35:2762.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Predicting rtPA Associated ICH in Acute Stroke

Department of Neurology, Stroke Program, Indiana University School of Medicine, Indianapolis, Indiana

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

I read with interest the study by Trouillas et al from Lyon, France,¹ describing a plasma marker associated with parenchymal brain hemorrhage in patients treated with intravenous recombinant tissue plasminogen activator (rtPA) for acute stroke. Unusually high D-dimer levels measured at 2 hours after beginning rtPA were associated with increased risk of parenchymal hemorrhage within 24 hours. This is useful information that could be translated to patients treated elsewhere with a similar protocol. However, the currently adopted protocol for intravenous rtPA treatment of acute stroke in the United States and many other countries is according to the American Stroke Association (ASA)² and the American Academy of Neurology (AAN)³ guidelines, and these guidelines differ in 2 important ways from the protocol used in Lyon. I would like to point out that because of these differences, the findings from Lyon may not translate to centers that follow the ASA/AAN guidelines.

First, the ASA/AAN guidelines do not recommend treatment beyond 3 hours after symptom onset, compared with up to 7 hours in Lyon. The mean delay to starting intravenous rtPA in Lyon was nearly 4 hours (based on a previous publication from that center),⁴ which is approximately 90 minutes later than in the United States. This difference may be important as longer exposure to brain ischemia, with greater injury to the blood vessels and surrounding tissue, may predispose to hemorrhagic complications more than shorter exposure.

Second, the ASA/AAN guidelines advise against anticoagulation within 24 hours after rtPA treatment, compared with . . . [Full Text of this Article]

Paul Trouillas, MD, PhD; Laurent Derex, MD; Fréderic Philippeau, MD; Norbert Nighoghossian, MD Jerome Honnorat, MD

Cerebrovascular Unit, Neurological Hospital, Lyon, France

Michel Hanss, MD Patrick French, MD

Hemostasis Department, Cardiological Hospital, Lyon, France

Patrice Adeleine, PhD

Biostatistical Laboratory, Lyon, France

Marc Dechavanne, MD

Hemostasis Laboratory, Lyon, France