Safety and efficacy of intravenous thrombolysis for ischemic stroke in an elderly patient with thrombocytopenia

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Background: Strokes remain as one of the diseases with high mortality and morbidity, which can be prevented through prompt and concise treatment. Intravenous thrombolysis (IV-rTPA) is the mainstay treatment for hyperacute ischemic stroke with onsets of less than 4.5 hours. However, it has several contraindications that should be monitored, one of them being thrombocytopenia. Objectives: This case report details the use of IV-rTPA in a geriatric patient with thrombocytopenia to highlight its efficacy and safety. Case: An 85-year-old woman was admitted to the emergency ward with weakness in the left extremities, slurred speech, and upward-right gaze one hour prior to ER admission. She had a significant history of hypertension and type II diabetes mellitus. A physical examination revealed a muscle strength of +5/+1, palsy in the left 7th and 12th cranial nerves, an NIHSS score of 15, and a RACE score of 7. The laboratory result was positive for thrombocytopenia (96,000/μl). IV-rTPA was administered, and two hours later, the patient's NIHSS score raised to 11. During the IV-RTPA administration, there was minor gum bleeding, which was considered insignificant. The patient was admitted to the ICU and observed for the next 72 hours. No signs of bleeding or clinical deterioration were observed during that period. Numerous studies have confirmed IV-rTPA's efficacy in acute ischemic stroke treatment if administered before 4.5 hours of onset. Thrombocytopenia is known as a contraindication of IV-rTPA, which may increase the risk of bleeding. In this case, IV-rTPA was administered due to hyperacute onset and no known history of bleeding despite low platelet count. Conclusion: IV-rTPA may be considered if the benefits outweigh the risks, coupled with thorough monitoring of the patient's condition.