Abstract P26: Association of Tranexamic Acid Use With Outcomes in Alteplase-Associated Intracranial Hemorrhage

Autor: Jimmy Chen, Shadi Yaghi, Meaghan Demers-Peel, Sharon Heaton, Vivien H. Lee, Eva Mistry, Shahid M Nimjee, Ava L. Liberman, Thomas Snyder, Nicholas Andrews, Liqi Shu, Leana Mahmoud, Cassandra Forrest, Brian Silver, Shawna Cutting, Dhrumil Vaishnav, Megan Spinney, Scott Moody, Andrew R. Zullo
Rok vydání: 2021
Předmět:
Zdroj: Stroke. 52
ISSN: 1524-4628
0039-2499
Popis: Background: Alteplase (tPA) is the standard of care in acute ischemic stroke (AIS) treatment, but it is associated with increased risk of symptomatic intracranial hemorrhage (sICH). Cryoprecipitate (Cryo) is recommended for tPA-associated sICH reversal. Tranexamic acid (TXA), an antifibrinolytic, is of interest as an adjunct therapy, but data in AIS is limited. We aim to assess the relationship of TXA and sICH reversal. Methods: We conducted a multicenter retrospective cohort study of AIS patients admitted between April 2015 and July 2020 who were treated for tPA-associated sICH. Patients with extracranial bleeds, who were not reversed, or who died within 24 hours were excluded. Demographics, clinical characteristics, imaging, and outcome data were collected from electronic health records. Outcomes included hematoma expansion, a poor functional outcome at 90 days (modified Rankin Score 3-6), and thrombotic events. We used Pearson chi-square, Fisher’s exact, and Wilcoxon rank-sum tests to compare outcomes between adjunct TXA treatment (TXA+Cryo) vs. Cryo only groups. Results: The study cohort included 30 patients with tPA-related sICH (mean age 80 ±12.4 years; 60% female). Overall median (IQR) hematoma size was 4.4 ml (1.1-20). Multifocal bleeds were present in 39% of patients. TXA+Cryo was administered in 16 (53%) patients. Initial hematoma size was smaller in the TXA+Cryo group than the Cryo only group, median (IQR) of 2.4 ml (0.5-14.3) vs 24.1 ml (2.5-56.5), p=0.043. However, there were no marked differences between TXA+Cryo and the Cryo only groups for hematoma expansion (5 [33%] vs. 6 [50%] patients, p=0.38), poor functional outcome (15 [94%] vs. 11 [79%] patients, p=0.32), or thrombotic events (1 [6%] vs. 0, p=1.00). Conclusion: Among patients treated for tPA-related sICH, there was no difference in hematoma expansion, poor functional outcome, or thrombotic events in patients treated with adjunct TXA compared to Cryo alone.
Databáze: OpenAIRE
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