Is intravenous thrombolysis safe for acute ischemic stroke patients taking warfarin with INR 1.9?

Abstract

Introduction: Intravenous thrombolysis is not suitable for patients undergoing oral anticoagulants therapy, with INR > 1.7 or PT > 15 s. We described a case of intravenous thrombolysis in a patient with INR 1.9. Patient concerns: A 66-year-old female patient was diagnosed with acute appendicitis complicated with atrial fibrillation. Seven days after admission, the patient suffered mixed aphasia with right limb asthenia. The NIHSS score was 11 points. and early infarction and hemorrhagic manifestations were not found in the emergency head CT. Thirty minutes after the onset of symptoms, NIHSS of patient increased from 11 to 14, but the INR was 1.92. Diagnosis: Acute ischemic stroke. Interventions: The IT therapy was recommended and all the therapy related risks were explained to the patient's parents. Briefly, the patient was given rTPA 38.5 mg. In addition to intravenous thrombolysis, VitK1 40 mg was simultaneously administered. Outcome: The patient's symptoms of drowsiness were improved. After 24 hours, all symptoms were stabilized with NIHSS of 2 points, there was a slight language obstruction, and no hemorrhagic transformation in head CT. Three months later, the review showed MRS score of 0, and the patient could take care of herself in daily life. Conclusion: The clinical guidelines are still the main reference for guiding clinical practice, and the main thrombolytic standards and contraindications for treatment still need to be conformed. On this basis, for individualized patients, clinicians must accurately judge the cause of acute stroke, to make optimal choice, reduce disability and mortality, and improve quality of life of patients.

Successful intravenous thrombolysis in an acute ischemic stroke patient with contraindicating values of the international standardized ratio and prothrombin time

“…A large cross-sectional study [8] found that the prognosis of patients with an INR > 1.7 was the same as that of the other patients. Two cases have successfully reported the use of IVT in patients presenting with AIS and an INR of 1.9 (the INR was not as high as our case, and PT and detailed changes of blood coagulation function were not mentioned) [9,10]. Thus, IVT with rt-PA may not increase the risk of symptomatic intracranial hemorrhage (sICH) or poor prognosis in warfarin-treated stroke patients with an INR > 1.7.…”