Intravenous thrombolysis and platelet count.

Détails

ID Serval
serval:BIB_7DA9D88AFCFF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Intravenous thrombolysis and platelet count.
Périodique
Neurology
Auteur(s)
Gensicke H., Al Sultan A.S., Strbian D., Hametner C., Zinkstok S.M., Moulin S., Bill O., Zini A., Padjen V., Kägi G., Pezzini A., Seiffge D.J., Traenka C., Räty S., Amiri H., Zonneveld T.P., Lachenmeier R., Polymeris A., Roos Y.B., Gumbinger C., Jovanovic D.R., Curtze S., Sibolt G., Vandelli L., Ringleb P.A., Leys D., Cordonnier C., Michel P., Lyrer P.A., Peters N., Tatlisumak T., Nederkoorn P.J., Engelter S.T.
Collaborateur(s)
Thrombolysis in Stroke Patients (TRISP) Collaborators
Contributeur(s)
Béjot Y., Daubail B., Giroud M., Hervieu-Bègue M., Osseby G.V., Bodenant M., Bordet R., Cordonnier C., Debette S., Dequatre N., Dumont F., Hénon H., Jacquet C., Lefebvre C., Leys D., Mendyk A.M., Moulin S., Curtze S., Putaala J., Sibolt G., Strbian D., Tatlisumak T., Berrouschot J., Erdur H., Koch P., Nolte C.H., Scheitz J.F., Hametner C., Ringleb P., Kellert L., Padovani A., Pezzini A., Bigliardi G., Dell'Acqua M.L., Vandelli L., Nichelli P., Zini A., Nederkoorn P.J., Roos Y.B., Zinkstok S.M., Zonneveld T.P., Spaander F., Beslac Bumbasirevic L., Jovanovic D.R., Padjen V., Stefanovic Budimkic M., Stanarcevic P., Berisavac I., Ercegovac M., Bonati L.H., De Marchis G.M., Engelter S.T., Gensicke H., Hert L., Lyrer P.A., Peters N., Polymeris A., Traenka C., Seiffge D.J., Arnold M., Heldner M.R., Sarikaya H., Bill O., Eskandari A., Michel P., Kaegi G., Wegener S., Luft A.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Statut éditorial
Publié
Date de publication
20/02/2018
Peer-reviewed
Oui
Volume
90
Numéro
8
Pages
e690-e697
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
To 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 × 10 <sup>9</sup> /L is supported.
In 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 × 10 <sup>9</sup> /L), thrombocytosis (>450 × 10 <sup>9</sup> /L), and normal PC (150-450 × 10 <sup>9</sup> /L [reference group]). Moreover, PC < 100 × 10 <sup>9</sup> /L was compared to PC ≥ 100 × 10 <sup>9</sup> /L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated.
Among 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 × 10 <sup>9</sup> /L) was associated with increasing risk of sICH (OR <sub>adjusted</sub> 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (OR <sub>adjusted</sub> 0.99, 95% CI 0.98-0.99) and mortality (OR <sub>adjusted</sub> 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (OR <sub>adjusted</sub> 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (OR <sub>adjusted</sub> 0.89, 95% CI 0.39-1.97) and mortality (OR <sub>adjusted</sub> 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (OR <sub>adjusted</sub> 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 10 <sup>9</sup> /L. Their risks of sICH (OR <sub>unadjusted</sub> 1.56, 95% CI 0.48-5.07), poor outcome (OR <sub>adjusted</sub> 1.63, 95% CI 0.82-3.24), and mortality (OR <sub>adjusted</sub> 1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC ≥ 100 × 10 <sup>9</sup> /L.
Lower 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 × 10 <sup>9</sup> /L is challenged.
Mots-clé
Administration, Intravesical, Aged, Aged, 80 and over, Female, Hemorrhage/epidemiology, Humans, Male, Middle Aged, Platelet Count, Prospective Studies, Registries, Risk Factors, Stroke/blood, Stroke/drug therapy, Stroke/epidemiology, Survival Analysis, Thrombocytopenia/epidemiology, Thrombocytosis/epidemiology, Thrombolytic Therapy/adverse effects
Pubmed
Web of science
Création de la notice
01/02/2018 22:00
Dernière modification de la notice
20/08/2019 15:38
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