Intravenous thrombolysis and platelet count

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Fältnamn	Indikatorer	Metadata
000		05156naa a2200829 4500
001		oai:gup.ub.gu.se/267619
003		SwePub
008		240528s2018 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://gup.ub.gu.se/publication/2676192 URI
024	7	a https://doi.org/10.1212/wnl.00000000000049822 DOI
040		a (SwePub)gu
041		a eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Gensicke, H.4 aut
245	1 0	a Intravenous thrombolysis and platelet count
264		c 2018-01-24
264	1	b Ovid Technologies (Wolters Kluwer Health),c 2018
520		a ObjectiveTo study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 x 10(9)/L is supported.MethodsIn this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 x 10(9)/L), thrombocytosis (>450 x 10(9)/L), and normal PC (150-450 x 10(9)/L [reference group]). Moreover, PC < 100 x 10(9)/L was compared to PC 100 x 10(9)/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated.ResultsAmong 7,533 IVT-treated stroke patients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 x 10(9)/L) was associated with increasing risk of sICH (ORadjusted 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (ORadjusted 0.99, 95% CI 0.98-0.99) and mortality (ORadjusted 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (ORadjusted 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (ORadjusted 0.89, 95% CI 0.39-1.97) and mortality (ORadjusted 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (ORadjusted 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 x 10(9)/L. Their risks of sICH (ORunadjusted 1.56, 95% CI 0.48-5.07), poor outcome (ORadjusted 1.63, 95% CI 0.82-3.24), and mortality (ORadjusted 1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC 100 x 10(9)/L.ConclusionLower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 x 10(9)/L is challenged.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Medicinska och farmaceutiska grundvetenskaperx Neurovetenskaper0 (SwePub)301052 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Basic Medicinex Neurosciences0 (SwePub)301052 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
653		a acute ischemic-stroke
653		a tissue-plasminogen activator
653		a health-care
653		a professionals
653		a clinical-practice
653		a iv thrombolysis
653		a volume
653		a therapy
653		a thrombocytopenia
653		a association
653		a guidelines
653		a Neurosciences & Neurology
700	1	a Al Sultan, A. S.4 aut
700	1	a Strbian, D.4 aut
700	1	a Hametner, C.4 aut
700	1	a Zinkstok, S. M.4 aut
700	1	a Moulin, S.4 aut
700	1	a Bill, O.4 aut
700	1	a Zini, A.4 aut
700	1	a Padjen, V.4 aut
700	1	a Kagi, G.4 aut
700	1	a Pezzini, A.4 aut
700	1	a Seiffge, D. J.4 aut
700	1	a Traenka, C.4 aut
700	1	a Raty, S.4 aut
700	1	a Amiri, H.4 aut
700	1	a Zonneveld, T. P.4 aut
700	1	a Lachenmeier, R.4 aut
700	1	a Polymeris, A.4 aut
700	1	a Roos, Y. B.4 aut
700	1	a Gumbinger, C.4 aut
700	1	a Jovanovic, D. R.4 aut
700	1	a Curtze, S.4 aut
700	1	a Sibolt, G.4 aut
700	1	a Vandelli, L.4 aut
700	1	a Ringleb, P. A.4 aut
700	1	a Leys, D.4 aut
700	1	a Cordonnier, C.4 aut
700	1	a Michel, P.4 aut
700	1	a Lyrer, P. A.4 aut
700	1	a Peters, N.4 aut
700	1	a Tatlisumak, Turgutu Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi,Institute of Neuroscience and Physiology4 aut0 (Swepub:gu)xtatlt
700	1	a Nederkoorn, P. J.4 aut
700	1	a Engelter, S. T.4 aut
710	2	a Göteborgs universitetb Institutionen för neurovetenskap och fysiologi4 org
773	0	t Neurologyd : Ovid Technologies (Wolters Kluwer Health)g 90:8q 90:8x 0028-3878x 1526-632X
856	4 8	u https://gup.ub.gu.se/publication/267619
856	4 8	u https://doi.org/10.1212/wnl.0000000000004982

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