Intravenous thrombolysis and platelet count

Henrik Gensicke; Abdulaziz S Al Sultan; Daniel Strbian; Christian Hametner; Sanne M Zinkstok; Solène Moulin; Olivier Bill; Andrea Zini; Visnja Padjen; Georg Kägi; Alessandro Pezzini; David J Seiffge; Christopher Traenka; Silja Räty; Hemasse Amiri; Thomas P Zonneveld; Romina Lachenmeier; Alexandros Polymeris; Yvo B Roos; Christoph Gumbinger; Dejana R Jovanovic; Sami Curtze; Gerli Sibolt; Laura Vandelli; Peter A Ringleb; Didier Leys; Charlotte Cordonnier; Patrik Michel; Philippe A Lyrer; Nils Peters; Turgut Tatlisumak; Paul J Nederkoorn; Stefan T Engelter; Thrombolysis in Stroke Patients (TRISP) Collaborators

doi:10.1212/WNL.0000000000004982

Intravenous thrombolysis and platelet count

Neurology. 2018 Feb 20;90(8):e690-e697. doi: 10.1212/WNL.0000000000004982. Epub 2018 Jan 24.

Authors

Henrik Gensicke¹, Abdulaziz S Al Sultan², Daniel Strbian², Christian Hametner², Sanne M Zinkstok², Solène Moulin², Olivier Bill², Andrea Zini², Visnja Padjen², Georg Kägi², Alessandro Pezzini², David J Seiffge², Christopher Traenka², Silja Räty², Hemasse Amiri², Thomas P Zonneveld², Romina Lachenmeier², Alexandros Polymeris², Yvo B Roos², Christoph Gumbinger², Dejana R Jovanovic², Sami Curtze², Gerli Sibolt², Laura Vandelli², Peter A Ringleb², Didier Leys², Charlotte Cordonnier², Patrik Michel², Philippe A Lyrer², Nils Peters², Turgut Tatlisumak², Paul J Nederkoorn², Stefan T Engelter²; Thrombolysis in Stroke Patients (TRISP) Collaborators

Affiliations

¹ 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.S., S.R., S.C., G.S., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (C.H., H.A., C.G., P.A.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.M.Z., T.P.Z., Y.B.R., P.J.N.), Academic Medical Center, Amsterdam, the Netherlands; University Lille (S.M., D.L., C.C.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France; Department of Neurology (O.B., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Stroke Unit (A.Z., L.V.), Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy; Neurology Clinic (V.P., D.R.J.), Clinical Centre of Serbia, Belgrade; Department of Neurology (G.K.), Kantonsspital St. Gallen, Switzerland; Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Institute of Neuroscience and Physiology (T.T.), Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Switzerland. [email protected].
² 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.S., S.R., S.C., G.S., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (C.H., H.A., C.G., P.A.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.M.Z., T.P.Z., Y.B.R., P.J.N.), Academic Medical Center, Amsterdam, the Netherlands; University Lille (S.M., D.L., C.C.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France; Department of Neurology (O.B., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Stroke Unit (A.Z., L.V.), Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy; Neurology Clinic (V.P., D.R.J.), Clinical Centre of Serbia, Belgrade; Department of Neurology (G.K.), Kantonsspital St. Gallen, Switzerland; Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Institute of Neuroscience and Physiology (T.T.), Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Switzerland.

PMID: 29367438
DOI: 10.1212/WNL.0000000000004982

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 (OR_adjusted 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (OR_adjusted 0.99, 95% CI 0.98-0.99) and mortality (OR_adjusted 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (OR_adjusted 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (OR_adjusted 0.89, 95% CI 0.39-1.97) and mortality (OR_adjusted 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (OR_adjusted 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 10⁹/L. Their risks of sICH (OR_unadjusted 1.56, 95% CI 0.48-5.07), poor outcome (OR_adjusted 1.63, 95% CI 0.82-3.24), and mortality (OR_adjusted 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.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intravesical
Aged
Aged, 80 and over
Female
Hemorrhage / epidemiology*
Humans
Male
Middle Aged
Platelet Count
Prospective Studies
Registries
Risk Factors
Stroke / blood*
Stroke / drug therapy*
Stroke / epidemiology
Survival Analysis
Thrombocytopenia / epidemiology
Thrombocytosis / epidemiology
Thrombolytic Therapy / adverse effects*