NINDS was published in 1995. We’ve been using tPA and other thrombolytics for myocardial infarction since well before that. But, we still have no effective way to manage post-thrombolysis intracranial hemorrhage.
This retrospective registry review of 921 patients at the University of Texas identified 48 patients with symptomatic intracranial hemorrhage after tPA thrombolysis for acute stroke. 11 received FFP alone, 7 received FFP and cryoprecipitate, and 1 received cryoprecipitate. Only two patients (4.6%) had mRS 0-2 after sICH, neither of whom received blood product administration. There were baseline differences between groups, but overall mortality for any sICH was 41.8% – which may or may not be worse than mRS 4 or 5.
A 2010 review found similar futility in pro-coagulant administration, though in an even smaller case-series. If the widespread proponents of tPA would like to subject ever-increasing numbers of patients to this complication, perhaps they ought to put as much energy into developing new treatments for hemorrhage as they do vilifying tPA skeptics?
“Clotting Factors to Treat Thrombolysis-related Symptomatic Intracranial Hemorrhage in Acute Ischemic Stroke.”
http://www.ncbi.nlm.nih.gov/pubmed/24321775
Post-script: Thomas Deloughery writes in to note this has been recognized as a problem since at least 1989 … with zero progress since that time:
“Bleeding during thrombolytic therapy for acute myocardial infarction: mechanisms and management.”
http://www.ncbi.nlm.nih.gov/pubmed/2688504