There are currently no data from randomised control trials to guide and assess safety of tissue plasminogen activator (tPA) in ischaemic stroke presenting with high blood pressure (HBP). We aimed to assess the rates of intracranial haemorrhage (ICH), and risk of bleeding associated with HBP prior or after the start of tPA.Methods
Retrospective single-centre study of post-thrombolysis ICH in ischaemic stroke presented as FAST-alerts. All patients had post-thrombolysis CT head at 24 hours, which were reviewed to diagnose/define haemorrhagic transformation. HBP was defined as BP >185/110 mmHg. The rates of post-tPA ICH on follow-up scans with and without HBP were assessed.Results
Of 152 ischaemic stroke subjects (mean age: 73.8, 51% male), 62 patients (mean age: 74.5, 48% male) were given tPA according to the guidelines. One patient (1.5%) had symptomatic ICH (type-1 parenchymal haematoma), 4 (5.9%) asymptomatic ICH, and 92.5% had no ICH on the follow-up scans. 10 patients (16%) had HBP necessitating intravenous antihypertensive treatments. Of these, 90% did not have haemorrhagic complications.Conclusion
The risk of post-tPA parenchymal haematoma in stroke patients with HBP is small even for those in need of intravenous antihypertensive therapy. Guidelines on management of HBP for safe-administration of tPA are lacking.