Intracerebral hemorrhage complicating intravenous tissue plasminogen activator treatment
S. E. Carlson, M. S. Aldrich, H. S. Greenberg and E. J. Topol
Department of Neurology, University of Michigan Medical Center, Ann Arbor.
Tissue plasminogen activator's thrombolytic action is relatively specific
for fibrin; however, systemic bleeding can occur in patients, especially
when heparin is simultaneously administered. We describe two cases of
intracerebral hemorrhage from a cohort of 450 patients (0.44%) treated at
one institution with tissue plasminogen activator and heparin for acute
myocardial infarction. A pooled worldwide review of 5258 cases from several
clinical protocols for treatment of acute myocardial infarction, using
tissue plasminogen activator from one source, revealed a similar overall
incidence of 0.68%. The incidence of intracerebral hemorrhage may be
reduced by lowering the total dose of tissue plasminogen activator or by
reducing the infusion rate and duration. The incidence of central nervous
system hemorrhage with tissue plasminogen activator is within the range
reported with streptokinase, but because equal coronary artery thrombolytic
doses are not known, no definitive comparison is possible.
