Abstract TP48: IV-tPA In Elderly With Occult Trauma Is Associated With High Risk For Hemorrhagic Complication
Autor: | Ali Sultan-qurraie, Michael C Previti, Erin Eddington Alden, Jennifer Han, Nazanin Sheibani, Adam H de Havenon |
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Rok vydání: | 2022 |
Předmět: | |
Zdroj: | Stroke. 53 |
ISSN: | 1524-4628 0039-2499 |
DOI: | 10.1161/str.53.suppl_1.tp48 |
Popis: | Intro: IV-tPA was approved for the treatment of acute ischemic stroke in 1996. IV-tPA administration in the setting of trauma can propagate hemorrhagic complications, such as Disseminated Intravascular Coagulation, which can be difficult to reverse especially in the elderly. Robust data on outcomes in patients with undiagnosed traumatic fracture receiving IV-tPA for acute ischemic stroke is lacking. Our study investigates the safety of IV-tPA in patients with occult trauma. Methods: We reviewed our database over a three-year period, August 2018 to August 2021, for complications of reperfusion therapy as defined and reported to GWTG registry. These charts were retrospectively reviewed for patients who were determined to have presented with acute traumatic fracture. Results: IV-tPA was administered 329 times. 18 total hemorrhagic complications were discovered. Four of these patients presented with occult acute traumatic fracture - three had rib fractures; one had pelvic fracture. Hypovolemic shock was attributed to the respective traumatic fracture in all cases. All required blood products and intravenous fluid resuscitation. Three patients underwent invasive treatment in an attempt to abort or alleviate hemorrhagic complication including intercostal artery embolization, video-assisted thoracoscopic surgery, thoracentesis, and internal iliac artery branch embolization. Two patients developed a severe consumptive coagulopathy and suffered in-hospital death. All four patients were elderly, age range 83-90, median 87.5. All had presented with Emergent Large Vessel Occlusion (ELVO) and underwent Mechanical Thrombectomy (MT). Conclusion: Elderly patients with occult trauma may be at high-risk for serious hemorrhagic complication after receiving IV-tPA. Our findings suggest increased caution in administering IV-tPA to elderly with stigmata of trauma who may have underlying traumatic fracture. Our findings are relevant as alternatives to IV-tPA become available and as rapid advanced imaging enables individualized precision medicine - in elderly patients presenting with concomitant trauma and ELVO who are candidates for MT, the risk versus benefit of IV-tPA may be questioned. Larger studies are needed to validate our findings. |
Databáze: | OpenAIRE |
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