Is tPA Safe for Sickle Cell Patients in Acute Ischemic Stroke?

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832 patients with SCD and 3328 matched non-SCD controls were identified and compared in the analysis.
832 patients with SCD and 3328 matched non-SCD controls were identified and compared in the analysis.

New research has found that tissue plasminogen activator (tPA) can safely treat patients with sickle cell disease (SCD) who experience acute ischemic stroke.

Although SCD  is not a known contraindication to tPA therapy, the National Heart Lung and Blood Institute of the National Institutes of Health has recommended acute exchange transfusion for stroke in SCD instead due to its different pathophysiology.

Researchers from Medical University of South Carolina (MUSC) matched patients with and without SCD from the American Heart Association and the American Stroke Association Get With The Guidelines-Stroke registry. A comparison analysis then evaluated usage, complications and discharge outcomes after tPA in both groups.

A total of 832 patients with SCD and 3328 matched non-SCD controls were identified. Results showed that of SCD patients who received tPA, 4.9% experienced symptomatic intracranial hemorrhage vs 3.2% of those without SCD (=.4502). This difference was not statistically significant but researchers suggest it warrants further research. There was also no difference regarding in-hospital complications.

When administered in the requisite time frame, tPA can aid in preventing some of the disability associated with ischemic stroke. The study found no significant difference between the two groups in the number who received tPA (8.2% SCD vs 9.4% non-SCD) or in timing of administration (door-to-needle time, 73 minutes for SCD patients vs. 79 minutes for non-SCD patients).

Commenting on the study's results, lead author Robert J. Adams, MD, said, “Having sickle cell disease did not adversely affect any of the indicators we measured.”

“These findings suggest that a future randomized trial that compares using red-blood cell exchange alone versus combination therapy with tPA and red-blood cell exchange should be undertaken to evaluate the outcomes of ischemic stroke in patients with sickle cell disease,” noted co-author Julie Kanter, MD.

Reference

Adams RJ, Cox M, Ozark SD, et al. Coexistent sickle cell disease has no impact on the safety or outcome of lytic therapy in acute ischemic stroke. Stroke. 2017;48:686-691. doi:10.1161/STROKEAHA.116.015412

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