Repeated Intravenous Thrombolytic Treatment Experience with Tissue Plasminogen Activator in Patients with Acute Ischemic Stroke: Case series

Ischemic stroke treatment has been changing in recent years and these procedures have positive effects on patients' prognosis, morbidity, and mortality. Intravenous Treatment with Recombinant Tissue-Type Plasminogen Activator (iv r-tPA) is one of the most efficient approaches in ischemic stroke patients. When administered in the first 4.5 h from symptom onset, it has been proven to be effective in functional improvement. However, physicians may feel hesitant about administering these treatments regarding the possible complications,especially the patients with recurrent stroke. The aim of this article is to contribute to the literature on the efficacy and safety of recur-rent iv r-tPA therapy in patients with recurrent stroke. We present seven patients who underwent thrombolytic treatment more than one time between September 2017 and September 2020 and recorded the patients' gender, risk factors, age, initial/final National Institutes of Health Stroke Scale (NIHSS), and hemorrhagic transformation rates. Mean interval of iv r-TPA treatment was 244.7 days (minimum 58 days, maximum 1 year 9 months 10 days). Average of NIHSS calculated as 7.57 before the first and 8.26 before the second iv r-tPA treatment; at the time of discharge mean of NIHSS was 1.57 and 2.8 respectively for five patients. Five of the patients have been identified as cardioembolic in aetiology. In two of our cases, clinical worsening was observed in the follow-ups after iv r-tPA. Our symptomatic intracranial hemorrhage rates were similar to the literature seen in one patient. Rates of bleeding were directly proportional with calculated HAS-BLED scores in patients who were started anticoagulation. Our complication rates were similar with literature and the prognosis of recurrent r-tPA was discovered to have a good prognosis in the first 3 months.