Henrik Gensicke1, Abdulaziz S Al Sultan2, Daniel Strbian2, Christian Hametner2, Sanne M Zinkstok2, Solène Moulin2, Olivier Bill2, Andrea Zini2, Visnja Padjen2, Georg Kägi2, Alessandro Pezzini2, David J Seiffge2, Christopher Traenka2, Silja Räty2, Hemasse Amiri2, Thomas P Zonneveld2, Romina Lachenmeier2, Alexandros Polymeris2, Yvo B Roos2, Christoph Gumbinger2, Dejana R Jovanovic2, Sami Curtze2, Gerli Sibolt2, Laura Vandelli2, Peter A Ringleb2, Didier Leys2, Charlotte Cordonnier2, Patrik Michel2, Philippe A Lyrer2, Nils Peters2, Turgut Tatlisumak2, Paul J Nederkoorn2, Stefan T Engelter2. 1. From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D.S., S.R., S.C., G.S., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (C.H., H.A., C.G., P.A.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.M.Z., T.P.Z., Y.B.R., P.J.N.), Academic Medical Center, Amsterdam, the Netherlands; University Lille (S.M., D.L., C.C.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France; Department of Neurology (O.B., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Stroke Unit (A.Z., L.V.), Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy; Neurology Clinic (V.P., D.R.J.), Clinical Centre of Serbia, Belgrade; Department of Neurology (G.K.), Kantonsspital St. Gallen, Switzerland; Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Institute of Neuroscience and Physiology (T.T.), Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Switzerland. henrik.gensicke@usb.ch. 2. From the Stroke Center and Department of Neurology (H.G., D.J.S., C.T., R.L., A. Polymeris, P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Department of Clinical Neurosciences (H.G., A.S.A.S.), University of Calgary, Alberta, Canada; Department of Neurology (D.S., S.R., S.C., G.S., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (C.H., H.A., C.G., P.A.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.M.Z., T.P.Z., Y.B.R., P.J.N.), Academic Medical Center, Amsterdam, the Netherlands; University Lille (S.M., D.L., C.C.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France; Department of Neurology (O.B., P.M.), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Stroke Unit (A.Z., L.V.), Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy; Neurology Clinic (V.P., D.R.J.), Clinical Centre of Serbia, Belgrade; Department of Neurology (G.K.), Kantonsspital St. Gallen, Switzerland; Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Institute of Neuroscience and Physiology (T.T.), Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Switzerland.
Abstract
OBJECTIVE: To study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 109/L is supported. METHODS: In this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 × 109/L), thrombocytosis (>450 × 109/L), and normal PC (150-450 × 109/L [reference group]). Moreover, PC < 100 × 109/L was compared to PC ≥ 100 × 109/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated. RESULTS: Among 7,533 IVT-treated stroke patients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 × 109/L) was associated with increasing risk of sICH (ORadjusted 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (ORadjusted 0.99, 95% CI 0.98-0.99) and mortality (ORadjusted 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (ORadjusted 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (ORadjusted 0.89, 95% CI 0.39-1.97) and mortality (ORadjusted 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (ORadjusted 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 109/L. Their risks of sICH (ORunadjusted 1.56, 95% CI 0.48-5.07), poor outcome (ORadjusted 1.63, 95% CI 0.82-3.24), and mortality (ORadjusted 1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC ≥ 100 × 109/L. CONCLUSION: Lower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 109/L is challenged.
OBJECTIVE: To study the effect of platelet count (PC) on bleeding risk and outcome in strokepatients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 109/L is supported. METHODS: In this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months. PC was used as a continuous and categorical variable distinguishing thrombocytopenia (<150 × 109/L), thrombocytosis (>450 × 109/L), and normal PC (150-450 × 109/L [reference group]). Moreover, PC < 100 × 109/L was compared to PC ≥ 100 × 109/L. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from the logistic regression models were calculated. RESULTS: Among 7,533 IVT-treated strokepatients, 6,830 (90.7%) had normal PC, 595 (7.9%) had thrombocytopenia, and 108 (1.4%) had thrombocytosis. Decreasing PC (every 10 × 109/L) was associated with increasing risk of sICH (ORadjusted 1.03, 95% CI 1.02-1.05) but decreasing risk of poor outcome (ORadjusted 0.99, 95% CI 0.98-0.99) and mortality (ORadjusted 0.98, 95% CI 0.98-0.99). The risk of sICH was higher in patients with thrombocytopenic than in patients with normal PC (ORadjusted 1.73, 95% CI 1.24-2.43). However, the risk of poor outcome (ORadjusted 0.89, 95% CI 0.39-1.97) and mortality (ORadjusted 1.09, 95% CI 0.83-1.44) did not differ significantly. Thrombocytosis was associated with mortality (ORadjusted 2.02, 95% CI 1.21-3.37). Forty-four (0.3%) patients had PC < 100 × 109/L. Their risks of sICH (ORunadjusted 1.56, 95% CI 0.48-5.07), poor outcome (ORadjusted 1.63, 95% CI 0.82-3.24), and mortality (ORadjusted 1.38, 95% CI 0.64-2.98) did not differ significantly from those of patients with PC ≥ 100 × 109/L. CONCLUSION: Lower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 109/L is challenged.
Authors: Valerian L Altersberger; Lars Kellert; Abdulaziz S Al Sultan; Nicolas Martinez-Majander; Christian Hametner; Ashraf Eskandari; Mirjam R Heldner; Sophie A van den Berg; Andrea Zini; Visnja Padjen; Georg Kägi; Alessandro Pezzini; Alexandros Polymeris; Gian M DeMarchis; Marjaana Tiainen; Silja Räty; Stefania Nannoni; Simon Jung; Thomas P Zonneveld; Stefania Maffei; Leo Bonati; Philippe Lyrer; Gerli Sibolt; Peter A Ringleb; Marcel Arnold; Patrik Michel; Sami Curtze; Paul J Nederkoorn; Stefan T Engelter; Henrik Gensicke Journal: Eur Stroke J Date: 2019-11-13
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: Anna Falanga; Avi Leader; Chiara Ambaglio; Zsuzsa Bagoly; Giancarlo Castaman; Ismail Elalamy; Ramon Lecumberri; Alexander Niessner; Ingrid Pabinger; Sebastian Szmit; Alice Trinchero; Hugo Ten Cate; Bianca Rocca Journal: Hemasphere Date: 2022-07-13
Authors: Jan F Scheitz; Henrik Gensicke; Sanne M Zinkstok; Sami Curtze; Marcel Arnold; Christian Hametner; Alessandro Pezzini; Guillaume Turc; Andrea Zini; Visnja Padjen; Susanne Wegener; Annika Nordanstig; Lars Kellert; Georg Kägi; Yannick Bejot; Patrik Michel; Didier Leys; Christian H Nolte; Paul J Nederkoorn; Stefan T Engelter Journal: BMJ Open Date: 2018-09-17 Impact factor: 2.692