تقرير
Intravenous thrombolysis in acute ischemic stroke after antagonization of unfractionated heparin with protamine: case series and systematic review of literature.
| العنوان: | Intravenous thrombolysis in acute ischemic stroke after antagonization of unfractionated heparin with protamine: case series and systematic review of literature. |
|---|---|
| المؤلفون: | Kneer K; Centre for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany.; Department of Neurology and Epileptology, Eberhard Karl University of Tübingen, Tübingen, Germany.; Hertie Institute for Clinical Brain Research, Tübingen, Germany., Adeyemi AK; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany., Sartor-Pfeiffer J; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany., Wilke V; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany., Blum C; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany., Ziemann U; Centre for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany.; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany.; Hertie Institute for Clinical Brain Research, Tübingen, Germany., Poli S; Centre for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany.; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany.; Hertie Institute for Clinical Brain Research, Tübingen, Germany., Mengel A; Centre for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany.; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Tübingen, Germany.; Hertie Institute for Clinical Brain Research, Tübingen, Germany., Feil K; Department of Neurology & Stroke, Eberhard Karl University of Tübingen, Hopple-Seyler- Strasse 3, 72076 Tübingen, Germany.; Centre for Neurovascular Diseases Tübingen (ZNET), Tübingen, Germany.; Hertie Institute for Clinical Brain Research, Tübingen, Germany. |
| المصدر: | Therapeutic advances in neurological disorders [Ther Adv Neurol Disord] 2023 Jan 24; Vol. 16, pp. 17562864221149249. Date of Electronic Publication: 2023 Jan 24 (Print Publication: 2023). |
| نوع المنشور: | Case Reports |
| اللغة: | English |
| بيانات الدورية: | Publisher: SAGE Country of Publication: England NLM ID: 101480242 Publication Model: eCollection Cited Medium: Print ISSN: 1756-2856 (Print) Linking ISSN: 17562856 NLM ISO Abbreviation: Ther Adv Neurol Disord Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: London : SAGE, 2008- |
| مستخلص: | Background and Aims: Intravenous thrombolysis (IVT) is standard of care for disabling acute ischemic stroke (AIS) within a time window of ⩽ 4.5 h. Some AIS patients cannot be treated with IVT due to limiting contraindications, including heparin usage in an anticoagulating dose within the past 24 h or an elevated activated prothrombin time (aPTT) > 15 s. Protamine is a potent antidote to unfractionated heparin. Objectives: The objective of this study was to investigate the safety and efficacy of IVT in AIS patients after antagonization of unfractionated heparin with protamine. Methods: Patients from our stroke center (between January 2015 and September 2021) treated with IVT after heparin antagonization with protamine were analyzed. National Institutes of Health Stroke Scale (NIHSS) was used for stroke severity and modified Rankin Scale (mRS) for outcome assessment. Substantial neurological improvement was defined as the difference between admission and discharge NIHSS of ⩾8 or discharge NIHSS of ⩽1. Good outcome at follow-up after 3 months was defined as mRS 0-2. Safety data were obtained for mortality, symptomatic intracerebral hemorrhage (sICH), and for adverse events due to protamine. Second, a systematic review was performed searching PubMed and Scopus for studies and case reviews presenting AIS patients treated with IVT after heparin antagonization with protamine. The search was limited from January 1, 2011 to September 29, 2021. Furthermore, we conducted a propensity score matching comparing protamine-treated patients to a control IVT group without protamine (ratio 2:1, match tolerance 0.2). Results: A total of 16 patients, 5 treated in our hospital and 11 from literature, [65.2 ± 13.1 years, 37.5% female, median premorbid mRS (pmRS) 1 (IQR 1, 4)] treated with IVT after heparin antagonization using protamine were included and compared to 31 IVT patients [76.2 ± 10.9 years, 45% female, median pmRS 1 (IQR 0, 2)]. Substantial neurological improvement was evident in 68.8% of protamine-treated patients versus 38.7% of control patients ( p = 0.028). Good clinical outcome at follow-up was observed in 56.3% versus 58.1% of patients ( p = 0.576). No adverse events due to protamine were reported, one patient suffered sICH after secondary endovascular thrombectomy of large vessel occlusion. Mortality was 6.3% versus 22.6% ( p = 0.236). Conclusion: IVT after heparin antagonization with protamine seems to be safe and, prospectively, may extend the number of AIS patients who can benefit from reperfusion treatment using IVT. Further prospective registry trials would be helpful to further investigate the clinical applicability of heparin antagonization. Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: K.F. received funding for research from Boehringer Ingelheim outside of this study (Lexi Study), speaker honoraria from Pfizer, and funding for research throughout the AKF program (Applied Clinical Research) of the University of Tübingen (No. 496-0-0, ANNES). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© The Author(s), 2023.) |
| References: | Stroke. 2010 Jul;41(7):1450-8. (PMID: 20538701) ASAIO J. 1993 Jul-Sep;39(3):M715-8. (PMID: 8268631) JAMA. 1999 Dec 1;282(21):2019-26. (PMID: 10591384) Stroke. 2007 Jun;38(6):1911-5. (PMID: 17463316) J Extra Corpor Technol. 2020 Mar;52(1):63-70. (PMID: 32280146) Anesth Analg. 2002 Jun;94(6):1402-8, table of contents. (PMID: 12031996) Neurologist. 2018 Nov;23(6):194-196. (PMID: 30379743) Stroke. 2021 Aug;52(9):3054-3062. (PMID: 34320814) Stroke. 2018 Mar;49(3):e46-e110. (PMID: 29367334) Blood Coagul Fibrinolysis. 2017 Apr;28(3):261-263. (PMID: 27214037) Pharmacotherapy. 2017 Oct;37(10):e103-e106. (PMID: 28741720) Int Anesthesiol Clin. 2004 Summer;42(3):135-45. (PMID: 15205644) Neurohospitalist. 2015 Jul;5(3):173-81. (PMID: 26288675) Trials. 2011 Nov 30;12:252. (PMID: 22129158) J Neurol. 2013 Nov;260(11):2911-2. (PMID: 24141734) Stroke. 2013 Mar;44(3):727-33. (PMID: 23391774) Lancet. 2014 Nov 29;384(9958):1929-35. (PMID: 25106063) Int J Stroke. 2014 Dec;9(8):992-8. (PMID: 23088381) Stroke. 2002 Sep;33(9):2243-6. (PMID: 12215594) Stroke. 2014 Jan;45(1):231-8. (PMID: 24253540) Pharmacotherapy. 2004 Aug;24(8 Pt 2):103S-107S. (PMID: 15334855) Circ Cardiovasc Qual Outcomes. 2013 Sep 1;6(5):543-9. (PMID: 24046398) FASEB J. 2017 Jun;31(6):2507-2519. (PMID: 28242772) Stroke. 1994 Nov;25(11):2220-6. (PMID: 7974549) J Am Coll Cardiol. 2008 Mar 4;51(9):906-11. (PMID: 18308158) J Surg Res. 1995 Feb;58(2):197-204. (PMID: 7861773) Stroke. 2012 May;43(5):1401-3. (PMID: 22308254) Stroke. 2016 Feb;47(2):581-641. (PMID: 26696642) Lancet. 2000 May 13;355(9216):1670-4. (PMID: 10905241) Am J Ther. 2018 Sep/Oct;25(5):e552-e554. (PMID: 29199997) Expert Opin Drug Metab Toxicol. 2016 Aug;12(8):897-909. (PMID: 27223896) Stroke. 2012 Apr;43(4):1171-8. (PMID: 22426314) Ann Neurol. 2021 Jan;89(1):42-53. (PMID: 32996627) J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104283. (PMID: 31324409) Stroke. 1989 Jul;20(7):864-70. (PMID: 2749846) Int J Stroke. 2020 Jan;15(1):39-45. (PMID: 31226920) Eur J Vasc Endovasc Surg. 2016 Sep;52(3):296-307. (PMID: 27389942) Can Med Assoc J. 1973 May 19;108(10):1291-7. (PMID: 4122234) Lancet. 1998 Oct 17;352(9136):1245-51. (PMID: 9788453) Surgery. 1996 Feb;119(2):123-8. (PMID: 8571194) Eur J Neurol. 2021 Jan;28(1):117-123. (PMID: 32812674) N Engl J Med. 2016 Jun 16;374(24):2313-23. (PMID: 27161018) N Engl J Med. 2008 Sep 25;359(13):1317-29. (PMID: 18815396) |
| فهرسة مساهمة: | Keywords: acute ischemic stroke; antagonization; heparin; intravenous thrombolysis; protamine; revascularization |
| تواريخ الأحداث: | Date Created: 20230130 Latest Revision: 20230202 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC9880584 |
| DOI: | 10.1177/17562864221149249 |
| PMID: | 36710724 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder كن أول من يترك تعليقا!