INTRACRANIAL HEMORRHAGE COMPLICATING ACUTE MYOCARDIAL-INFARCTION IN THE ERA OF THROMBOLYTIC THERAPY

Cerebrovascular accidents are one of the most serious causes of morbid ity in patients sustaining an acute myocardial infarction. In patients who do not receive thrombolytic therapy, the most common form of stro ke is thromboembolic, occurring in up to 2.4% of patients, predominant ly in those sustaining large anterior infarctions. In patients receivi ng thrombolytic therapy, intracranial hemorrhage is the most common fo rm of stroke, occurring in 0.1% to 1.4%. Predisposing conditions for i ntracranial bleeding include low body weight, female sex, advanced age , use of oral anticoagulant medication before the administration of ly tic therapy, diastolic blood pressure greater than 110 mm Hg, and the specific thrombolytic agent administered. Hematologic management of th e patient sustaining a hemorrhagic cerebrovascular accident should inc lude (1) discontinuance of thrombolytic therapy, anticoagulants, and a ntiplatelet agents and (2) infusion of cryoprecipitate to replenish fi brinogen. In certain cases, administration of fresh frozen plasma, pro tamine sulfate, and exogenous platelets may be required. Finally, evac uation of the hematoma may provide the most definitive form of treatme nt in selected cases.