on March 22, 2007
Published online before print March 22, 2007, doi: 10.1161/STROKEAHA.106.480889
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Submitted on December 20, 2006
From the Departments of Neurology (B.L.C., B.J., S.R.M.) and Medicine (M.W.), University of Pennsylvania Medical Center, Philadelphia, Pa. * To whom correspondence should be addressed. 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 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.
Accepted on January 6, 2007
Usefulness of Checking Platelet Count Before Thrombolysis in Acute Ischemic Stroke
Brett L. Cucchiara MD*;
100 000 before thrombolysis; however, obtaining this laboratory test may delay treatment.
Key words: platelet count • stroke • thrombolysis