Severe Fibrinolytic Disorder Caused by Intravenous Thrombolysis in a Patient With Acute Ischemic Stroke: A Case Report and Literature Review.

Introduction: Acute ischemic stroke (AIS) is one of the leading causes of morbidity and mortality in adults worldwide. Intravenous injection of recombinant tissue plasminogen activator is an established and effective treatment for AIS patients. The most common adverse effects of alteplase are hemorrhagic complications.

Case report: In this report, we highlight a rare but severe complication-primary fibrinolysis-following alteplase administration. A 68-year-old man without any cardiocerebral vascular diseases presented with the sudden onset of hemiplegia on the right. The initial National Institutes of Health Stroke Scale (NIHSS) score was 3, consisting of motor dysfunction in the right upper limb (score of 1) and lower limb (score of 2). Brain computed tomography (CT) revealed no evidence of hemorrhage. We conducted a standard dose of intravenous alteplase (IVT) for this patient. However, the patient had a terrible fibrinolytic system with extremely low fibrinogen after 8 hours of IVT (FIB <0.01, Clauss method). Immediate administration of 10 units of cryoprecipitate restored coagulation function, with significant improvement observed within 48 hours.

Conclusion: This case underscores the importance of vigilant coagulation monitoring in AIS patients undergoing alteplase therapy. Furthermore, infusion of cryoprecipitate for these patients indicated obvious therapeutic effects.