scholarly journals Point-of-Care International Normalized Ratio Measurements to Assess Eligibility for Thrombolysis in Acute Ischemic Stroke: Some Thoughts

Stroke ◽  
2010 ◽  
Vol 41 (5) ◽  
Author(s):  
Neha Subhash Dangayach ◽  
Tanmay S. Panchabhai
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Point Of Care ◽  
International Normalized Ratio

scholarly journals Is point-of-care accurate for indicating thrombolysis in anticoagulated patients on oral anticoagulation treatments?

2014 ◽  
Vol 72 (7) ◽  
pp. 487-489 ◽  
Author(s):  
Tatiana P. Bruch ◽  
Danielle C. Mendes ◽  
Jeff C. Pedrozo ◽  
Lívia Figueiredo ◽  
Edison M. Nóvak ◽  
...  
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulation ◽  
Point Of Care ◽  
High Sensitivity ◽  
International Normalized Ratio ◽  
Anticoagulation Treatment ◽  
Anticoagulated Patients

The use of oral anticoagulation treatment (OAT) in patients with an international normalized ratio (INR) higher than 1.7 is a contraindication to thrombolysis in acute ischemic stroke. The aim of the present study is to compare the use of point-of-care (POC) coagulometers to the standard coagulation analysis (SCA) procedure of the INR as a decision-making test for use with patients taking OAT. Method: Eighty patients on chronic OAT underwent a POC and an SCA during a regular outpatient evaluation. Results: When comparing the abilities of the POC test and the SCA test to identify adequate levels for thrombolysis (≤1.7), the POC had a sensitivity of 96.6% (95%CI 88.4-99.1) and a specificity of 60.0% (95%CI 38.6-78). POC overestimated INR levels by 0.51 points compared to the SCA test. Conclusion: POC has a high sensitivity compared to the SCA test for the identification of patients within the cut-off point for thrombolysis.

scholarly journals Point-of-Care International Normalized Ratio Testing Accelerates Thrombolysis in Patients With Acute Ischemic Stroke Using Oral Anticoagulants

Stroke ◽  
2009 ◽  
Vol 40 (11) ◽  
pp. 3547-3551 ◽  
Author(s):  
Timolaos Rizos ◽  
Christian Herweh ◽  
Ekkehart Jenetzky ◽  
Christoph Lichy ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Point Of Care ◽  
Oral Anticoagulants ◽  
International Normalized Ratio

scholarly journals Effect of Alteplase Administration on International Normalized Ratio in Patients With Acute Ischemic Stroke

2019 ◽  
Vol 10 (3) ◽  
pp. 176-180
Author(s):  
Michael J. Erdman ◽  
K. Erin Davidson ◽  
J. Tyler Haller ◽  
Samarth Shah ◽  
Whitney Gross ◽  
...  
Keyword(s):  
African American ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Occurrence Rate ◽  
Bleeding Events ◽  
Point Increase ◽  
Increased Risk ◽  
African American Race

Background/Objective: Alteplase may elevate international normalized ratio (INR) results, although the exact rate of elevation occurrence is not firmly established in the literature. The purpose of this study is to determine the occurrence rate of INR elevation following alteplase administration. We also aimed to determine what factors are independently associated with the development of elevated INR following alteplase administration for ischemic stroke. Methods: We conducted a multicenter, retrospective, cohort study of patients who received alteplase for acute ischemic stroke. Patients were screened for baseline INR measurement and a repeat value within 24 hours of alteplase administration. The primary outcome was the percent of patients who experienced ≥0.4-point increase in INR. Secondary outcomes included the rate of adverse bleeding events and identification of factors independently associated with elevated INR following alteplase administration. Results and Conclusions: Two hundred and sixty-one patients were included, with 44 (16.9%) patients having an INR increase of 0.4 or more. Patients with an INR increase ≥0.4 experienced a nonstatistically significant increase in bleeding episodes (8.8% vs 18.2%; P = .10). We identified African American race (odds ratio, 3.48, 95% confidence interval, 1.5-7.6; P = .002) as an independent predictor of INR increase ≥0.04. An INR elevation is common following receipt of alteplase for ischemic stroke. Those of African American race were at increased risk of INR elevation; however, more studies are needed to determine whether these patients are at a higher bleeding risk as a result of INR elevation.

Endovascular stroke therapy may be safe in patients with elevated international normalized ratio

2016 ◽  
Vol 9 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Sibu Mundiyanapurath ◽  
Anne Tillmann ◽  
Markus Alfred Möhlenbruch ◽  
Martin Bendszus ◽  
Peter Arthur Ringleb
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
International Normalized Ratio ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
University Hospital ◽  
Increased Risk

IntroductionEndovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials.ObjectiveTo analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values.MethodsRetrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy. Patients with anticoagulation other than vitamin K antagonists were excluded. The primary safety endpoint was defined as symptomatic intracranial hemorrhage (sICH; ECASS II definition). The efficacy endpoint was the modified Rankin scale (mRS) score after 3 months, dichotomized into favorable outcome (mRS 0–2) and unfavorable outcome (mRS 3–6).Results435 patients were included. 90% were treated with stent retriever. 27 (6.2%) patients with an INR of 1.2–1.7 and 21 (4.8%) with an INR >1.7. 33 (7.6%) had sICH and 149 patients (34.3%) had a favorable outcome. Patients with an elevated INR did not have an increased risk for sICH or unfavorable outcome in multivariable analysis. The additional use of IV thrombolysis in patients with an INR of 1.2–1.7 did not increase the risk of sICH or unfavorable outcome. These results were replicated in a sensitivity analysis introducing an error of the INR of ±5%. They were also confirmed using other sICH definitions (Safe Implementation of Thrombolysis in Stroke (SITS), National Institute of neurological Disorders and Stroke (NINDS), Heidelberg bleeding classification).ConclusionsEndovascular therapy in patients with an elevated INR is safe and efficient. Patients with an INR of 1.2–1.7 may be treated with combined IV thrombolysis and endovascular therapy.

scholarly journals Brain Natriuretic Peptide is a Predictor of Cardiac Thrombus in Critically Ill Acute Ischemic Stroke Patients

2020 ◽  
Vol 8 (B) ◽  
pp. 119-124
Author(s):  
Hossam A. Mowafy ◽  
Hossam El Sherif ◽  
Khaled A. Wahab ◽  
Nora I. Abbas ◽  
Gihan El Hilaly ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Natriuretic Peptide ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Significant Positive Correlation ◽  
Inverse Correlation ◽  
International Normalized Ratio ◽  
Diagnostic Biomarker ◽  
Positive Correlation ◽  
Cardiac Thrombus

CONTEXT: Plasma brain natriuretic peptide (BNP) levels are elevated in patients with acute ischemic stroke, particularly when accompanied by atrial fibrillation (AF). Plasma BNP might be a useful marker of vulnerability to thromboembolism in non-valvular AF patients. AIM: The aim of the present study was to assess whether the BNP level can serve as a biomarker of the left atrial (LA) thrombus in AF patients with acute ischemic stroke. SETTINGS AND DESIGN: This was a multicenter prospective cohort study. PATIENTS AND METHODS: Thirty AF patients with acute ischemic stroke were included in the study. Their transesophageal echocardiography (TEE) and BNP were assessed. RESULTS: There was a positive significant relation between serum BNP levels and LA thrombus detection by TEE. BNP with a cutoff value >498 pg/l can be used as a diagnostic biomarker for the presence of the LA thrombus. A significant positive correlation existed between serum BNP and LA diameter. Furthermore, a statistically significant positive correlation between serum BNP and AF rate and duration was found in all patients. In addition, a statistically significant inverse correlation was detected between serum BNP and direct bilirubin, international normalized ratio, and albumin. A statistically significant positive correlation existed between serum BNP and prothrombin concentration. CONCLUSION: BNP can be a good diagnostic biomarker for the detection of the LA thrombus in chronic AF patients with acute ischemic stroke.

scholarly journals Point-of-care coagulation testing for reducing in-hospital delay in thrombolysis

2018 ◽  
Vol 26 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Jung Hee Han ◽  
Seongsoo Jang ◽  
Mi-Ok Choi ◽  
Mi-Jeong Yoon ◽  
Seung-Bok Lim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prothrombin Time ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Intravenous Thrombolysis ◽  
International Normalized Ratio ◽  
Interquartile Range ◽  
Time Interval ◽  
Central Laboratory ◽  
Point Of Care Testing

Background: The confirmation of prothrombin time international normalized ratio by a central laboratory often delays intravenous thrombolysis in patients with acute ischemic stroke. Objectives: We investigated the feasibility, reliability, and usefulness of point-of-care determination of prothrombin time international normalized ratio for stroke thrombolysis. Methods: Among 312 patients with ischemic stroke, 202 who arrived at the emergency room within 4.5 h of stroke onset were enrolled in the study. Patients with lost orders for point-of-care testing for the prothrombin time international normalized ratio or central laboratory testing for the prothrombin time international normalized ratio (n = 47) were excluded. We compared international normalized ratio values and the time interval from arrival to the report of test results (door-to-international normalized ratio time) between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio. In patients who underwent thrombolysis, we compared the time interval from arrival to thrombolysis (door-to-needle time) between the current study population and historic cohort at our center. Results: In the 155 patients included in the study, the median door-to-international normalized ratio time was 9.0 min (interquartile range, 5.0–12.0 min) for point-of-care testing for the prothrombin time international normalized ratio and 46.0 min (interquartile range, 38.0–55.0 min) for central laboratory testing for the prothrombin time international normalized ratio (p < 0.001). The intraclass correlation coefficient between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio was 0.975 (95% confidence interval: 0.966–0.982). Forty-nine of the 155 patients underwent intravenous thrombolysis. The door-to-needle time was significantly decreased after implementation of point-of-care testing for the prothrombin time international normalized ratio (median, 23.0 min; interquartile range, 16.0–29.8 vs median, 46.0 min; interquartile range, 33.5–50.5 min). Conclusion: Utilization of point-of-care testing for the prothrombin time international normalized ratio was feasible in the management of patients with acute ischemic stroke. Point-of-care testing for the prothrombin time international normalized ratio was quick and reliable and had a pivotal role in expediting thrombolysis.

scholarly journals Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid

2019 ◽  
Vol 4 (1) ◽  
pp. 55-58
Author(s):  
Cynthia Romero ◽  
Samuel Shartar ◽  
Michael Carr
Keyword(s):  
Ischemic Stroke ◽  
Tranexamic Acid ◽  
Acute Ischemic Stroke ◽  
Cardiac Tamponade ◽  
Major Bleeding ◽  
Point Of Care ◽  
Pericardial Tamponade ◽  
Point Of Care Ultrasound ◽  
Blood Products ◽  
Tissue Plasminogen

Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA’s fibrinolytic effects.

Prior Anticoagulant Therapy, Subtherapeutic International Normalized Ratio and Thrombolytic Therapy in Acute Ischemic Stroke

2011 ◽  
Vol 6 (6) ◽  
pp. 568-569 ◽  
Author(s):  
Irene Miedema ◽  
Alex Gosselt ◽  
Jacques de Keyser ◽  
Karen Koopman ◽  
Berry Kremer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Anticoagulant Therapy ◽  
International Normalized Ratio

Elevated International Normalized Ratio as a Manifestation of Post-thrombolytic Coagulopathy in Acute Ischemic Stroke

2014 ◽  
Vol 23 (8) ◽  
pp. 2139-2144 ◽  
Author(s):  
Vivien H. Lee ◽  
James J. Conners ◽  
Shawna Cutting ◽  
Sarah Y. Song ◽  
Richard A. Bernstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
International Normalized Ratio
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