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Medline ® Abstract for Reference 55

of 'Intravenous fibrinolytic (thrombolytic) therapy in acute ischemic stroke: Therapeutic use'

55
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Treatment of intracerebral hemorrhage with tranexamic acid after thrombolysis with tissue plasminogen activator.
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French KF, White J, Hoesch RE
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Neurocrit Care. 2012 Aug;17(1):107-11.
 
BACKGROUND: Thrombolytic treatment with intravenous tissue plasminogen activator (i.v. tPA) is the only FDA-approved therapy for acute ischemic stroke. There are risks associated with thrombolytics, including intracranial and extracranial hemorrhage and hypersensitivity reactions. Established treatment for post-tPA hemorrhage includes administration of blood products including cryoprecipitate, fresh frozen plasma, and platelets which have poorly established efficacy. Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) have been studied as hemostatic therapies in post-operative hemorrhage, menorrhagia, intracranial hemorrhage (ICH), subarachnoid hemorrhage, and trauma patients. There is no reported literature on the use of TXA to reverse thrombolytic therapy with tPA.
METHODS: This is a case report of a Jehovah's Witness patient who was unwilling to receive blood products after developing symptomatic ICH following i.v. tPA. He consequently received TXA for reversal of thrombolytic therapy.
RESULTS: The patient received a total of 1.675 g of i.v. TXA within 3 h of finishing the iv tPA. Repeat brain imaging with computed tomography and magnetic resonance imaging revealed no further expansion of hemorrhages.
CONCLUSION: TXA is an inexpensive medication which competitively inhibits the activation of plasminogen and can be given to reverse thrombolysis in the setting of hemorrhage after i.v. thrombolytic therapy.
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Department of Neurology, Clinical Neurosciences Center, University of Utah School of Medicine, 175 N Medical Drive East, Salt Lake City, UT, Utah 84132, USA. Kris.french@hsc.utah.edu
PMID