Risk of immediate heparin after rt-PA therapy in acute ischemic stroke

The efficacy of rt-PA treatment within 3 h in patients with acute ischemic stroke was recently demonstrated in two large, double-blind, randomized trials. The role of postthrombolytic heparin therapy in stroke still remains unclear as anticoagulation was not allowed during the first 24 h in most larger studies, The risk of combining thrombolytic with immediate anticoagulant therapy was e-valuated in 43 consecutive patients with acute stroke, Thrombolysis (NINDS protocol) was followed by intravenous heparin aiming to double aPTT, Clinical course and CT were assessed after 24 h for signs of intracranial bleeding, The data of our series were compared to those of the present literature, Hemorrhagic conversion was found in 9 patients (21%), only one elf them had symptomatic parenchymal hematoma (2.3%). In this small, open study the risk of symptomatic hemorrhagic complication after combined therapy does not seem to be markedly greater than after thrombolysis alone.