Safety and Efficacy of Intravenous Thrombolysis for Ischemic Stroke in Elderly Patient with Thrombocytopenia

Abstract

Introduction: Stroke remains as one of the diseases with a high mortality and morbidity which could be prevented by a prompt and concise treatment. Intravenous thrombolysis (IV-rTPA) is the mainstay treatment for hyperacute ischemic stroke with onset less than 4.5 hours. However, there are several contraindications that should be monitored, one of them being thrombocytopenia. We would like to report the use of IV-rTPA in geriatric patient with thrombocytopenia to highlight the efficacy and safety profile of the drug. Case Report: A 85-year-old woman was admitted to the emergency ward with weakness on the left extremities, slurred speech, and right-upward gaze of the eyes one hour prior to the admission in ER. Her history was significant for hypertension and type II diabetes mellitus. Physical examination revealed a muscle strength of +5/+1, left 7th and 12th cranial nerves palsy, a NIHSS score of 15, and a RACE score of 7. The laboratory result was significant for thrombocytopenia (96.000/μl). IV-rTPA was administered and two hours later, we noticed an improvement of the patient’s NIHSS score to 11. During the IV-rTPA administration, we noted a minor gum bleed, 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. Discussion: Numerous studies have confirmed the efficacy of IV-rTPA in acute ischemic stroke 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 is administered due to hyperacute onset and no known history of bleeding, even though the platelet count was low. Therefore, IV-rTPA may be considered if the benefits outweigh the risks with a thorough monitoring of the patient’s condition.