Massive Hemothorax Following Thrombolysis With rtPA in a Stroke Patient With Undiagnosed Rib Fractures

Abstract

The majority of strokes are of ischaemic origin. Thrombolysis has led to a radical change in the outcome of these patients as far as management and prognosis. The main objective is the opening up of the occluded artery and early reperfusion of brain tissue. Only 2% to 4% of patients with acute ischemic stroke receive thrombolytic therapy resulting from the current strict inclusion criteria among other issues. Safety of intravenous and intraarterial thrombolysis in off-label situations is controversially discussed. The most feared complication related to the use of rtPA is intracerebral haemorrhage. Our case is an 84-year-old man who after receiving rtPA in the acute phase of a stroke, presented a massive hemothorax secondary to rib fractures which had not been previously diagnosed at admission. The neurological course was excellent and the hemothorax was resolved after inserting chest drainage. To obtain a meaningful database, a registry for off-label thrombolysis should be created.




J Med Cases. 2013;4(7):447-449
doi: http://dx.doi.org/10.4021/jmc1250w