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Lowering the bleeding risk in intra-arterial thrombolysis without losing efficiency by excluding adjunctive heparin?
  1. Paul Trouillas
  1. Correspondence to:
 Dr P Trouillas
 Service d’Urgences Neurovasculaires (Stroke Unit), Hôpital Neurologique et Neurochirurgical P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France

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Lowering the bleeding risk in intra-arterial thrombolysis without losing efficiency by excluding adjunctive heparin

Symptomatic intracerebral haemorrhage (sICH) is the main complication of intravenous (IVT) and intra-arterial thrombolysis (IAT). Factors of grave bleedings after thrombolysis have been recently reviewed.1 Immediate adjunctive heparin is classic in IAT. High doses of heparin may be suspected as a factor of bleeding in IAT on the basis of the Pro-Urokinase (r-proUK) for Acute Cerebral Thromboembolism (PROACT) I study, in which a higher sICH rate (27.3%) was observed in the high-heparin-dose subgroup, when compared with the low-heparin subgroup (6.7%). Even with the lower heparin regimen, the PROACT II study resulted in a sICH rate of …

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