{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T12:42:17Z","timestamp":1761050537240,"version":"build-2065373602"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,9,4]],"date-time":"2017-09-04T00:00:00Z","timestamp":1504483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:p>Few patients presenting with acute ischemic stroke (<jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>) are eligible for alteplase, especially those receiving ongoing anticoagulation. We describe the first reported case of a patient receiving full\u2010dose intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) alteplase for <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> after heparin reversal with protamine. A 73\u2010year\u2010old man presented with <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>. He was treated with <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> heparin, tirofiban, loading\u2010dose prasugrel, and aspirin before percutaneous coronary intervention (<jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>) for placement of a right coronary artery stent. One hour following <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>, he abruptly developed left hemiparesis and dysphagia. The National Institutes of Health Stroke Scale was 12, and activated partial thromboplastin time (<jats:styled-content style=\"fixed-case\">aPTT<\/jats:styled-content>) was longer than 150\u00a0seconds. Head computed tomography (CT) showed no acute pathology, and <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> angiogram showed no large\u2010vessel occlusion amenable to mechanical thrombectomy. Repeat <jats:styled-content style=\"fixed-case\">aPTT<\/jats:styled-content>, obtained 45\u00a0minutes later, was 110\u00a0seconds, at which time protamine 40\u00a0mg <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> was administered. At 144\u00a0minutes from last known well time, full\u2010dose <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> alteplase (0.9\u00a0mg\/kg) was administered. Follow\u2010up head imaging at 25\u00a0hours showed right pontine and cerebellar <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> with no evidence of hemorrhage. The patient was discharged to inpatient rehabilitation 2\u00a0days later. Modified Rankin Scale at 3\u00a0months was 3, improved from 5 at discharge. Given the lack of adverse events associated with <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> alteplase in our patient, we advocate cautious evaluation for potential reversal of acutely administered anticoagulation to facilitate alteplase administration in severely disabled patients who are not eligible for mechanical intervention and would have been excluded from definitive <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> treatment.<\/jats:p>","DOI":"10.1002\/phar.1997","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T06:58:11Z","timestamp":1500965891000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Alteplase for Acute Ischemic Stroke after Heparin Reversal with Protamine: A Case Report and Review"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4680-5720","authenticated-orcid":false,"given":"Gabriel V.","family":"Fontaine","sequence":"first","affiliation":[{"name":"Department of Pharmacy Intermountain Medical Center Salt Lake City Utah"},{"name":"Department of Neurology Intermountain Medical Center Salt Lake City Utah"},{"name":"Neurosciences Institute Intermountain Healthcare Salt Lake City Utah"},{"name":"University of Utah College of Pharmacy Salt Lake City Utah"},{"name":"Roseman University College of Pharmacy South Jordan Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shawn M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurology Intermountain Medical Center Salt Lake City Utah"},{"name":"Neurosciences Institute Intermountain Healthcare Salt Lake City 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