Abstract T P64: Cerebral Ischemic Events Associated with Intravenous Thrombolytic Administration in International Joint Efficacy Comparison of Thrombolytics (INJECT) Trial.

Abstract

Background: Platelet activation can be seen subsequent to thrombolytic administration leading to re-occlusion within coronary arteries. However, the occurrence of cerebral ischemic events secondary to thrombolytic administration is not well studied. Objective: To study the rate and outcome of patients with acute myocardial infarction [MI] who develop cerebral ischemic events within 48 hours of thrombolytic administration. Methods: A post-hoc analysis of the INJECT trial data was performed. Patients from 208 centers in nine countries (n = 6010) with acute myocardial infarction (<12 hr after symptom onset) were randomized to receive double-blind either streptokinase 1.5 MU intravenously over 60 min or reteplase two boluses of 10 MU given 30 min apart. All patients received intravenous heparin for at least 24 h. Ascertainment of ischemic stroke during hospitalization was performed throughout the study. Results: A total of 81 in-hospital strokes were observed in 6010 acute MI patients of which 47 were classified as ischemic events. A total of 29 (62%) suffered ischemic events within 48 hours of thrombolytic administration; 23 were ischemic stroke and 06 were transient ischemic attacks. The mean age (±SD) of the 29 patients was 70± (10) ; 20 were men. None of the patients had pre-existing or new onset atrial fibrillation. Underlying cardiac shock and heart failure was seen in 2 and 5 patients, respectively. IV heparin was continued for 24-72 hours in 11 patients. Survival was 66% (n=19) at 35 days and 55% (n=16) at 6 months. Conclusions: Most cerebral ischemic events occur in the immediate post-thrombolytic period and result in disproportionately low survival over 6 months.