Safety of intravenous thrombolysis in embolic stroke by infective endocarditis

Ischemic stroke is a serious neurological complication of infective endocarditis. Intravenous tissue plasminogen activator (t-PA), which has only been approved for treatment of hyperacute stroke, has been excluded as an ischemic stroke treatment due to infective endocarditis according to current expert consensus guidelines. Here, we describe a case of a hyperacute stroke patient treated with intravenous t-PA, who was later diagnosed with infective endocarditis. Neurology Asia 2013; 18(2) : 209 – 211 Address correspondence to: Do-Young, Kwon MD, PhD, Department of Neurology, Korea University Ansan Hospital, Gojan 1-Dong, Danwon-Gu, AnsanSi, Gyeonggi-Do, 152-703, South Korea. Tel: +82-31-412-5150; Fax: +82-31-412-5150. E-mail: [email protected] INTRODUCTION Ischemic stroke is one of the most common serious neurological complications from infective endocarditis. Intravenous tissue plasminogen activator (rt-PA) has not been considered for the treatment of ischemic stroke due to infective endocarditis, although it is a proven treatment for hyperacute stroke. In addition, cases of septic embolism have been excluded from large trials of thrombolytic agents, possibly due to a theoretical increase in risk of cerebral hemorrhage. There have not been any randomized trials to study the effects of a thrombolytic agent in the treatment of hyperacute stroke due to infective endocarditis, so the effi cacy and safety are still unknown. Here we describe a case of a hyperacute stroke patient who was treated by intravenous rt-PA, and was later diagnosed with infective endocarditis.