Acute Treatment of Thrombolysis-Associated Symptomatic Intracranial Hemorrhage: A Case Report

Alteplase (recombinant tissue plasminogen activator or rt-PA) remains the only approved treatment (and the quickest way to achieve thrombolyis) for acute ischemic stroke. Even if the most devastating complication of this therapy is symptomatic intracerebral hemorrhage (sICH) in up to 7% of patients, the overall benefits of rt-PA for stroke appear to outweigh the risks. However, as the development of sICH is associated with a worse outcome, clinicians caring for these patients are faced with the difficult decision what kind of treatment is best for them. Moreover, to date, there are no evidence-based guidelines as to the management of thrombolysis-associated sICH, most probably due to the fact that there is little original research on the question. Although the American Heart Association suggests empirical therapies to replace clotting factors and platelets, it also acknowledges the fact that there is a lack of evidence to support any specific therapy. Despite the lack of supporting evidence and the fact that some institutions and/or international organizations have developed care pathways for thrombolysis-associated sICH for current use, the most appropriate management of this complication is not yet clear.Herein we present a case of a male patient with thrombolysis-associated sICH successfully treated by high doses of cryoprecipitate and platelets. The role of replacing clotting factors and platelets in treatment of thrombolysis-associated sICH is also discussed.