Should we wait for routine laboratory findings before intravenous thrombolysis for ischemic stroke

Abstract

Objective To investigate whether routine laboratory findings should be awaited before intravenous thrombolytic therapy for ischemic stroke. Methods Emergency patients (including ischemic and non-ischemic stroke cases) treated at the Department of Neurology, Beijing Tsinghua Changgung Hospital between January 1st 2016 and October 1st 2017 were analyzed retrospectively. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR) in the first test were used as the main indicators. The proportion of patients with abnormalities between the overall population and the ischemic stroke subgroup was analyzed, and the above indicators between all patients with ischemic stroke and those receiving intravenous thrombolytic therapy were compared. The specific causes of failure to receive intravenous thrombolytic therapy in patients with ischemic stroke were analyzed descriptively. Results A total of 3 348 patients were enrolled. The emergency blood routine data were available in all patients. The emergency blood biochemical data were available in 3 278 patients (97.9%), and the emergency coagulation function data were available 1 742 patients (52.0%). There were no significant differences in the proportion of platelet count 36.5 s (3.8% vs. 3.6%; χ2=0.06, P=0.809), PT >15 s (2.6% vs. 2.8%; χ2=0.03, P=0.866), and INR>1.5 (2.0% vs. 2.0%; χ2=0.01, P=0.970) between the general population and the ischemic stroke subgroup. In a total of 687 patients with ischemic stroke, 57 (8.3%) received intravenous thrombolysis. There were no significant difference in mean platelet count, APTT, PT, and INR between the thrombolytic group and the entire ischemic stroke group. Forty-nine patients (5.1%) with ischemic stroke had abnormal main indicators, of which 57.1% (28/49) had a history of related diseases at the same time, while only 6.1% (3/49) had abnormal laboratory indicators as the main factor of contraindication for intravenous thrombolysis. Conclusions Patients with acute ischemic stroke (especially in the absence of a history of related disease) have a low proportion of abnormal blood test findings and are less likely to be the main contributor of contraindication for intravenous thrombolysis. Therefore, when there is no reason to suspect that the test findings are abnormal, intravenous thrombolytic therapy should not be delayed because of waiting for the test findings. Key words: Stroke; Brain ischemia; Thrombolytic therapy; Infusions, intravenous; Point-of-care systems; Time factors