Reversal of Acute Ischemic Stroke After THA Using Tissue Plasminogen Activator

May 2013
Orthopedics;May2013, Vol. 36 Issue 5, pe676
Academic Journal
Acute ischemic stroke is a potentially catastrophic medical emergency. Recently, successful reversal of the neurologic deficits associated with major ischemic strokes has been accomplished in selected patients through the use of intravenous tissue plasminogen activator (tPA), an agent that can accomplish thrombolysis of arterial clots if given within the first few hours after the onset of stroke. Because tPA works by thrombolysis of fresh clots, a potential exists for catastrophic hemorrhage if given to acute postoperative patients. Therefore, the use of tPA has never been studied in postoperative patients, and the safety of the drug in postoperative patients is unknown. The author describes a patient who had an acute ischemic stroke 2 days after total hip arthroplasty who was successfully treated with tPA without major complications. The patient was 51 years old and developed progressive facial droop, right arm paralysis, and dysarthria 2 days after elective hip arthroplasty. Imaging confirmed occlusion of the left middle cerebral artery. Neurologic recovery was believed to be unlikely without tPA. After tPA administration, the patient had full neurologic recovery within minutes but did develop a large (nondraining) hematoma and severe ecchymosis at the surgical site; a drop in hematocrit required 3 units of packed red blood cell transfusion. The wound did not develop skin necrosis, infection, or compartment syndrome, and the hematoma resolved within several weeks without the need for surgical intervention. The author describes the patient's specific circumstances, the decision-making process behind the use of tPA, and the need for contingency plans in the event that severe uncontrolled hemorrhage occurs. This information may be useful if other surgeons are faced with the dilemma of a major stroke in acute postoperative patients.


Related Articles

  • Ask the Experts. Use of Tissue Plasminogen Activator to Treat Acute Ischemic Stroke. Alexandrov, Anne W. // Critical Care Nurse;Oct2010, Vol. 30 Issue 5, p77 

    The article provides an answer to a question on the use of tissue plasminogen activator to treat acute ischemic stroke.

  • Thrombolysis for acute stroke in routine clinical practice.  // Current Medical Literature: Stroke Review;2003, Vol. 7 Issue 2, p57 

    Focuses on the use of thrombolysis for acute stroke in routine clinical practice. Delays in licensing tissue plasminogen activator for acute ischemic stroke; Protocol for administrating tissue plasminogen activator.

  • Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator.  // Current Medical Literature: Stroke Review;2003, Vol. 7 Issue 2, p56 

    Studies arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Assessment using transcranial Doppler after thrombolysis for acute ischemic stroke; Definition of reocclusion.

  • First clot buster approved for ischemic stroke. Cerrato, Paul L. // RN;Mar97, Vol. 60 Issue 3, p70 

    Reports on the tissue plasminogen activator's approval for the treatment of acute ischemic stroke. Effect on the disabilities caused by stroke; Serious complications of stroke.

  • Fatal ischaemic brain oedema after early thrombolysis with tissue plasminogen activator in acute stroke. Koudstaal, P.J.; Stibbe, J.; Vermeulen, M. // BMJ: British Medical Journal (International Edition);12/17/88, Vol. 297 Issue 6663, p1571 

    Investigates the occurrence of fatal ischemic brain edema after early thrombolysis with tissue plasminogen activator in acute stroke. Administration of a computed tomography scan; Symptoms of the disease; Causes of ischemic stroke.

  • Acute Ischemic Stroke and Timing of Treatment. Saver, Jeffrey L.; Fonarow, Gregg C.; Schwamm, Lee H. // JAMA: Journal of the American Medical Association;10/30/2013, Vol. 310 Issue 17, p1856 

    A response from the authors of the article "Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke," is presented.

  • Administration of Intravenous Tissue Plasminogen Activator in a Pediatric Patient With Acute Ischemic Stroke. Shuayto, Marwan I.; Lopez, J. Ivan; Greiner, Frank // Journal of Child Neurology;Jul2006, Vol. 21 Issue 7, p604 

    Intravenous tissue plasminogen activator is the only therapy approved by the US Food and Drug Administration (FDA) for the treatment of acute ischemic strokes. The National Institutes of Health (NIH)-sponsored study that led to the approval of tissue plasminogen activator to be used in acute...

  • t-PA FOR TREATING ACUTE ISCHEMIC STROKE. Shaughnessy, Allen S.; Scow, Dean Thomas // Journal of Family Practice;May96, Vol. 42 Issue 5, p458 

    The article discusses research being done on the use of tissue plasminogen activator (t-PA) for treating acute ischemic stroke. It references a study by the National Institute of Neurological Disorders and Stroke t-PA Stroke Study Group published in a 1995 issue of "The New England Journal of...

  • Rupture of a thoracic aortic aneurysm: a rare adverse reaction following systemic tissue plasminogen activator infusion. Hayashi, Hiromitsu; Kawamata, Hiroshi; Ichikawa, Kazuo; Tajima, Hiroyuki; Kumazaki, Tatsuo // Heart & Vessels;Jul2004, Vol. 19 Issue 4, p208 

    We present a patient with rupture of a thoracic aortic aneurysm occurring after systemic infusion of tissue plasminogen activator for the treatment of acute ischemic stroke, which was successfully treated with the placement of an endovascular stent-graft.

  • Acute Stroke – On the Threshold of a Therapy? del Zoppo, Gregory J. // New England Journal of Medicine;12/14/95, Vol. 333 Issue 24, p1632 

    The author suggests that the study reported in this issue, "Tissue plasminogen activator for acute ischemic stroke," by the NINDS rt-PA Stroke Study Group represents an important step forward in the treatment of stroke. He mentions that the benefits of tissue plasminogen activator in the...


Read the Article


Sign out of this library

Other Topics