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Thrombolysis safe for stroke patients taking warfarin
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Patients with acute ischemic stroke who are taking warfarin can be treated safely with tissue plasminogen activator, new data suggest.
“Although it’s only drug-approved by the FDA to treat acute ischemic stroke, tissue plasminogen activator (tPA) is underused among patients on home warfarin therapy mainly because of the fear that it will cause bleeding,” Ying Xian, MD, PhD, a research fellow at Duke Clinical Research Institute, said in a press release issued at the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions.
Using data from the AHA/American Stroke Association’s Get With The Guidelines–Stroke registry, researchers evaluated tPA safety in 23,472 warfarin-treated patients who had an ischemic stroke. All were treated in 1,203 Get With The Guidelines–Stroke hospitals between April 2009 and June 2011. Nearly 8% of patients were taking warfarin (Coumadin, Bristol-Myers Squibb) before admission.
Risk for intracranial hemorrhage was similar after adjustment among stroke patients who received tPA after stroke, regardless of warfarin use (adjusted OR=1.01; 95% CI, 0.82-1.25). Researchers noted a “marginally significant” trend toward higher crude intracranial hemorrhage rates among patients taking warfarin who had higher baseline INR levels (adjusted OR=1.1; 95% CI, 1.0-1.2).
Rates of serious systemic hemorrhage, any tPA complications and in-hospital mortality did not differ between patients taking warfarin and those not taking the drug.
On average, warfarin-treated patients were older (mean age, 77 years vs. 71 years) and had more comorbid illness and greater stroke severity.
“This represents the largest clinical experience of the safety of thrombolysis in warfarin-treated patients who meet clinical guideline eligibility criteria,” the researchers concluded.
For more information:
- Xian Y. Presentation #10. Presented at: the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions; May 9-11, 2012; Atlanta.
Disclosure: Dr. Xian reports no relevant financial disclosures.