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18 April 2017


Tissue plasminogenic activator may be a safe treatment for ischaemic stroke in adult patients with sickle cell disease, according to a new analysis.

Sickle cell patients have an increased risk of intracranial haemorrhage - but the latest study suggests this is not a significant complication of tPA.

Researchers in South Carolina, USA, examined outcomes for sickle cell patients compared with other stroke patients for the research, published in the journal Stroke.

The research compared outcomes for 823 patients with sickle cell disease against outcomes for another 3,325 patients matched by age, sex and race over a seven year period in 1,952 US hospitals taking part in a stroke quality improvement programme.

The study found small differences between the two groups of patients - but none that ranked as statistically significant.

Some 8.2% of sickle cell patients had tPA compared with 9.4% of controls. Among these patients, 4.9% suffered intracerebral haemorrhage compared with 3.2% of controls.

There was a greater in-hospital mortality rate among sickle cell patients - with an odds ratio of 1.21.

Researcher Professor Robert Adams, director of the South Carolina Center for Economic Excellence in Stroke, said; 'Having sickle cell disease did not adversely affect any of the indicators we measured.

'People with sickle cell disease and an acute stroke who would otherwise qualify for tPA did not have worse outcomes than stroke patients who did not have sickle cell disease.'

Fellow researcher Dr Julie Kanter, a haematologist, called for a randomised trial to compare red blood cell exchange with red blood cell exchange combined with tPA.

This would 'evaluate the outcomes of ischaemic stroke in patients with sickle cell disease.'

Source: Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke. Stroke 9 February 2017

Link: http://stroke.ahajournals.org/content/48/3/686


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