988-4 Hemorrhagic Stroke Associated with High aPTTs Following Thrombolytic Therapy and Heparin or Hirudin

Abstract

In GUSTO lla, 2564 patients with acute coronary syndrome with ST deviation and symptoms within 12 hours were randomized to hirudin (0.6 mg/kg bolus, 0.6 mg/kg/hr infusion with out adjustment) or IV heparin (5,000 U bolus, 1100 to 1300 U/hr adjusted tD a target aPTF of 60–90 seconds) for 3–5 days. The 26 patients who suffered hemorrhagic stroke, as expected from previous studies examining risk factors, were older (median age 71 vs 65). had higher initial systolic blood pressure (142 vs 134 mmHg) and were more commonly female (42 vs 31%). Unexpectedly, hemorrhagic stroke patients weighed more (82 vs 77 kg), which may have reflected weight-adjusted dosing and consequent administration of more anticoagulant. Of the 26 patients, 23 were treated with thrombolytic therapy. In spite of concern over renal dysfunction contributing to increased risk, the baseline and 48 hour creatinine was similar among hirudin treated patients with (1.2,1.2) and without (1.1,1.1) hemorrhagic stroke. APTT was a predictor of hemorrhagic stroke, particularly in the hirudin assigned group. Multivariable analysis will help to determine the relative importance of risk factors in GUSTO lla for hemorrhagic stroke, and whether the elevated aPTTs appear to fully explain the increased risk. These data illustrate the narrow therapeutic window for antithrombin therapy in conjuction with thrombolysis