Background: Platelet counts (PCs) <100,000/µl are considered as a contraindication for intravenous thrombolysis (IVT). While US guidelines recommend IVT initiation before the availability of clotting tests, the guidelines of the European Stroke Organization give no such practical advice. We aimed to assess the incidence of thrombocytopenia in IVT patients, outcome after thrombolysis in affected patients and the time gained by initiating treatment prior to availability of PC results. Methods: All patients with thrombocytopenia were identified in our prospectively acquired thrombolysis database. Baseline demographic data, intracerebral hemorrhage rates as well as functional outcome were assessed. The median time between initiation of thrombolysis and availability of PCs was calculated. Results: Of 625 IVT patients, 3 (0.5%) had thrombocytopenia at stroke onset. None of them developed intracerebral hemorrhage (ICH) or died during the follow-up. Waiting for PCs would have delayed treatment in 72.4% of the patients, with a median hypothetical delay of 22 min (interquartile range: 11–41 min). Conclusions: To date, there are no sufficient data to evaluate the ICH risk in thrombocytopenic patients. However, thrombocytopenia is rare in IVT patients. Thus, generally waiting for PC results prior to initiation of IVT is not warranted. Avoiding this significant delay yields shorter door-to-needle times and potentially more effective treatment.

1.
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581–1587.
2.
Hacke W, Kaste M, Bluhmki E, et al: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317–1329.
3.
European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008;25:457–507.
4.
Adams HP Jr, del Zoppo G, Alberts MJ, et al: Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007;38:1655–1711.
5.
Cucchiara BL, Jackson B, Weiner M, Messe SR: Usefulness of checking platelet count before thrombolysis in acute ischemic stroke. Stroke 2007;38:1639–1640.
6.
Meretoja A, Putaala J, Tatlisumak T, et al: Off-label thrombolysis is not associated with poor outcome in patients with stroke. Stroke 2010;41:1450–1458.
7.
Rost NS, Masrur S, Pervez MA, Viswanathan A, Schwamm LH: Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke. Neurology 2009;73:1957–1962.
8.
Lees KR, Bluhmki E, von Kummer R, et al: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010;375:1695–1703.
9.
Tanne D, Kasner SE, Demchuk AM, et al: Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 2002;105:1679–1685.
10.
Kohrmann M, Schellinger PD, Breuer L, et al: Avoiding in hospital delays and eliminating the three-hour effect in thrombolysis for stroke. Int J Stroke 2011;6:493–497.
11.
Slichter SJ: Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev 2004;18:153–167.
12.
Aledort LM, Hayward CP, Chen MG, Nichol JL, Bussel J: Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating antithrombopoietin antibodies. Am J Hematol 2004;76:205–213.
13.
Lee YJ, Jy W, Horstman LL, et al: Elevated platelet microparticles in transient ischemic attacks, lacunar infarcts, and multiinfarct dementias. Thromb Res 1993;72:295–304.
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