Is warfarin a contraindication to thrombolysis in acute ST elevation myocardial infarction?

Stanley, AG

doi:10.1136/hrt.2005.062158

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…In cases of myocardial infarction, hemorrhagic complications following thrombolytic treatment were not associated with the concomitant use of warfarin itself, but were associated with an initially high INR level (INR N 2.9) [19]. A small case series of stroke patients found that IA thrombolytic treatment could be performed successfully in patients on warfarin [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Of the 179 patients, 97 (54.2%) were male, the mean age was 69.1 ± 10.6 years (range, 30-87), and the median NIHSS score was 17.0 (range 4-38, interquartile range [13][14][15][16][17][18][19][20]. Seventy-one patients (39.7%) were treated with IV t-PA, 43 (24.0%) with IA urokinase and 65 (36.3%) with combined IV and IA thrombolytic therapy.…”

Section: Overall Baseline Characteristicsmentioning

confidence: 99%

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Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

Lee¹,

Jung²,

Choi³

et al. 2010

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 99%

Section: Overall Baseline Characteristicsmentioning

confidence: 99%

Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

Lee¹,

Jung²,

Choi³

et al. 2010

Journal of the Neurological Sciences

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“…9,10 However, there have been many reported data on good outcomes with fibrinolysis in high INR for other indications when potential benefits outweigh the risk. [11][12][13] We analysed the fibrinolytic regimens, safety and success of fibrinolysis in patients with left-sided PVT with high INR.…”

Section: Introductionmentioning

confidence: 99%

Fibrinolysis in left-sided mechanical prosthetic valve thrombosis with high INR

Nishanth

Shankar

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: A significant number of patients with prosthetic valve thrombosis have a prothrombin time international normalised ratio in the therapeutic range at presentation. Surgery may not be possible in many patients and traditionally a high international normalised ratio is considered a relative contraindication for fibrinolysis. Methods: We conducted an observational study in patients with left-sided obstructive prosthetic valve thrombosis with international normalised ratio at or above the therapeutic range at presentation who received fibrinolysis. The fibrinolytic regimens, timing of initiation, success of fibrinolysis, risk of major and minor bleeding and ischaemic stroke were evaluated in the study. Results: Of 30 patients included in the study 70% received immediate fibrinolysis and in 30% it was delayed. The majority of patients (90%) presented with New York Heart Association class III/IV symptoms. The mean international normalised ratio at fibrinolysis was 3.04 ± 0.70 in the immediate group and 2.42 ± 0.89 in the delayed group. Haemodynamically stable patients who had delayed initiation of fibrinolysis had a trend towards less bleeding without an increase in mortality. The rates of intracranial haemorrhage (0% vs. 7.7%), minor bleeding (12.5% vs. 25.1%) and ischaemic stroke (0% vs. 30.7%) were lower in patients who received low dose infusion compared to a conventional dose. Conclusions: Fibrinolysis can be considered in patients with prosthetic valve thrombosis with high international normalised ratio at presentation. For haemodynamically stable patients, delayed initiation of fibrinolysis is associated with a marginally lower bleeding risk without an increase in mortality. Low dose infusion may be considered over a conventional dose as it is associated with a lower incidence of ischaemic stroke and a good rate of valve function restoration with a trend towards less bleeding.

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“…Only a few studies concerning the use of fibrinolytic agents in anticoagulated patients are available. Stanley et al did not find significant difference in serious complications between warfarin and non-warfarin patients bleeding complications after fibrinolysis, but there was a trend towards a greater prevalence of serious bleedings with anticoagulated patients [ 17 ]. Their anticoagulated fibrinolysis patients' rate of any bleeding (4%) was noteworthy lower than we found in our material, but their amount of ICH (4%) was the same as in our study population (3%) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stanley et al did not find significant difference in serious complications between warfarin and non-warfarin patients bleeding complications after fibrinolysis, but there was a trend towards a greater prevalence of serious bleedings with anticoagulated patients [ 17 ]. Their anticoagulated fibrinolysis patients' rate of any bleeding (4%) was noteworthy lower than we found in our material, but their amount of ICH (4%) was the same as in our study population (3%) [ 17 ]. Stanley et al found that age, aspirin use and repeated fibrinolysis increases bleeding complications, but in our material no connection between increasing bleeding rates and age or aspirin use appeared.…”

Section: Discussionmentioning

confidence: 99%

Warfarin and fibrinolysis - a challenging combination: an observational cohort study

Saarinen

Puolakka

Boyd

et al. 2011

Scand J Trauma Resusc Emerg Med

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BackgroundPatients presenting with ST-segment elevation myocardial infarction (STEMI) frequently use warfarin. Fibrinolytic agents and warfarin both increase bleeding risk, but only a few studies have been published concerning the bleeding risk of warfarin-prescribed patients receiving fibrinolysis. The objective of this study was to define the prevalence for intracranial haemorrhage (ICH) or major bleeding in patients on warfarin treatment receiving pre-hospital fibrinolysis.MethodsThis was an observational cohort study. Data for this retrospective case series were collected in Helsinki Emergency Medical Service catchment area from 1.1.1997 to 30.6.2010. All warfarin patients with suspected ST-segment elevation myocardial infarction (STEMI), who received pre-hospital fibrinolysis, were included. Bleeding complications were detected from Medical Records and classified as ICH, major or minor bleeding.ResultsThirty-six warfarin patients received fibrinolysis during the study period. Fourteen patients had bleeding complications. One (3%, 95% CI 0-15%) patient had ICH, six (17%, 95% CI 7-32%) had major and seven (19%, 95% CI 9-35%) had minor bleeding. The only fatal bleeding occurred in a patient with ICH. Patients' age, fibrinolytic agent used or aspirin use did not predispose to bleeding complications. High International Normalized Ratio (INR) seemed to predispose to bleedings with values over 3, but no statistically significant difference was found.ConclusionsBleedings occur frequently in warfarin patients treated with fibrinolysis in the real world setting, but they are rarely fatal.

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Is warfarin a contraindication to thrombolysis in acute ST elevation myocardial infarction?

Cited by 7 publications

References 3 publications

Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

Fibrinolysis in left-sided mechanical prosthetic valve thrombosis with high INR

Warfarin and fibrinolysis - a challenging combination: an observational cohort study

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