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The Clinical Conundrum of Managing Ischemic Stroke in Patients with Immune Thrombocytopenia.
- Source :
-
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques [Can J Neurol Sci] 2021 Jan; Vol. 48 (1), pp. 38-46. Date of Electronic Publication: 2020 Jul 10. - Publication Year :
- 2021
-
Abstract
- Guidelines are lacking for management of acute ischemic stroke and stroke prevention in patients with immune thrombocytopenia (ITP). Our aim is to highlight the dilemma inherent in managing patients with both significant bleeding and thrombotic risk factors. In this review, we present two patients with history of ITP who presented with acute ischemic stroke and received tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT), a rare management strategy in this patient population. In addition, we identified 27 case reports of ischemic stroke in patients with ITP; none of them received tPA or EVT. Furthermore, there are 92 patients with significant thrombocytopenia with no available data regarding the cause of thrombocytopenia, who were acutely treated with tPA or EVT. Conclusive evidence cannot be determined based on these limited number of cases. Future multicenter prospective cohort studies in patients with ITP are needed to provide better evidence-based treatment plans. At present, treatment of acute ischemic stroke in patients with ITP requires close collaboration between hematology and vascular neurology experts to find a balance between the benefit and risk of hemorrhagic complications.
- Subjects :
- Fibrinolytic Agents therapeutic use
Humans
Multicenter Studies as Topic
Prospective Studies
Thrombectomy
Thrombolytic Therapy
Tissue Plasminogen Activator therapeutic use
Treatment Outcome
Brain Ischemia drug therapy
Brain Ischemia therapy
Endovascular Procedures
Ischemic Stroke
Purpura, Thrombocytopenic, Idiopathic drug therapy
Purpura, Thrombocytopenic, Idiopathic therapy
Stroke drug therapy
Stroke therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0317-1671
- Volume :
- 48
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
- Publication Type :
- Academic Journal
- Accession number :
- 32646527
- Full Text :
- https://doi.org/10.1017/cjn.2020.138