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Intravenous thrombolysis and platelet count.
Gensicke, Henrik; Al Sultan, Abdulaziz S; Strbian, Daniel; Hametner, Christian; Zinkstok, Sanne M; Moulin, Solène; Bill, Olivier; Zini, Andrea; Padjen, Visnja; Kägi, Georg; Pezzini, Alessandro; Seiffge, David J; Traenka, Christopher; Räty, Silja; Amiri, Hemasse; Zonneveld, Thomas P; Lachenmeier, Romina; Polymeris, Alexandros; Roos, Yvo B; Gumbinger, Christoph; Jovanovic, Dejana R; Curtze, Sami; Sibolt, Gerli; Vandelli, Laura; Ringleb, Peter A; Leys, Didier; Cordonnier, Charlotte; Michel, Patrik; Lyrer, Philippe A; Peters, Nils; Tatlisumak, Turgut; Nederkoorn, Paul J; Engelter, Stefan T.
Afiliação
  • Gensicke H; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Al Sultan AS; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Strbian D; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Hametner C; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Zinkstok SM; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Moulin S; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Bill O; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Zini A; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Padjen V; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Kägi G; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Pezzini A; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Seiffge DJ; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Traenka C; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Räty S; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Amiri H; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Zonneveld TP; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Lachenmeier R; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Polymeris A; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Roos YB; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Gumbinger C; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Jovanovic DR; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Curtze S; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Sibolt G; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Vandelli L; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Ringleb PA; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Leys D; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Cordonnier C; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Michel P; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Lyrer PA; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Peters N; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Tatlisumak T; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Nederkoorn PJ; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
  • Engelter ST; From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D
Neurology ; 90(8): e690-e697, 2018 02 20.
Article em En | MEDLINE | ID: mdl-29367438
ABSTRACT

OBJECTIVE:

To study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 109/L is supported.

METHODS:

In this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 × 109/L), thrombocytosis (>450 × 109/L), and normal PC (150-450 × 109/L [reference group]). Moreover, PC < 100 × 109/L was compared to PC ≥ 100 × 109/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated.

RESULTS:

Among 7,533 IVT-treated stroke patients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 × 109/L) was associated with increasing risk of sICH (ORadjusted 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (ORadjusted 0.99, 95% CI 0.98-0.99) and mortality (ORadjusted 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (ORadjusted 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (ORadjusted 0.89, 95% CI 0.39-1.97) and mortality (ORadjusted 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (ORadjusted 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 109/L. Their risks of sICH (ORunadjusted 1.56, 95% CI 0.48-5.07), poor outcome (ORadjusted 1.63, 95% CI 0.82-3.24), and mortality (ORadjusted 1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC ≥ 100 × 109/L.

CONCLUSION:

Lower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 109/L is challenged.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Acidente Vascular Cerebral / Hemorragia Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Ano de publicação: 2018 Tipo de documento: Article
Texto completo
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PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Acidente Vascular Cerebral / Hemorragia Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Neurology Ano de publicação: 2018 Tipo de documento: Article