Introduction: Although, the recently updated tPA label removed a history of intracranial hemorrhage (ICH) as a contraindication, there is very limited data on the safety of intravenous thrombolysis in chronic ICH. The purpose of this study is to evaluate the safety of intravenous tPA among patient with chronic ICH.
Methods: We analyzed consecutive patients who received intravenous tPA for stroke symptoms at three tertiary stroke centers in a five-year period. Patients without imaging confirmation of the old hemorrhage were excluded from the study. Outcome measures in our study were occurrences of symptomatic ICH and were defined according to European Cooperative Acute Stroke Study (ECASS)-III criteria combined with clinical deterioration of ≥4 points on NIHSS or death.
Results: Out of 1212 post tPA patients evaluated in this study, seven patients (age 72 ± 11, four men, median NIHSS 5, IQR [2-8], volume ICH 1-21 cm3) had a history and neuroimaging findings consistent with an old ICH. Patients with old ICH did not differ in terms of rates of symptomatic ICH (0%, 95%CI (0-32%) by the adjusted Wald method versus 3.6%, p=0.61) and in-hospital mortality (0% versus 6.0%, p=0.5) when compared with the rest of patients. There was no significance difference between two groups in terms of age and admission NIHSS. Out of seven patients, five patients had ICH in basal ganglia and two patients had ICH in pre-ventricular white matter region.
Discussion: Our study indicates that administration of intravenous tPA is safe among patients with a history of chronic ICH. More studies are needed to define chronic in such a setting.