TY - JOUR
T1 - Dasatinib Reinitiation After Poststroke Thrombolysis Associated with Symptomatic Intracerebral Hemorrhage
AU - Hamilton, Robert A.
AU - Hathidara, Mausaminben
AU - Shujaat, Syeda Dania
AU - Strickland, Allison E.
AU - Bohnstedt, Bradley N.
AU - Ray, Bappaditya
PY - 2019/5
Y1 - 2019/5
N2 - Background: Dasatinib, a tyrosine kinase inhibitor commonly used in treatment of acute lymphoblastic leukemia and chronic myelogenous leukemia, is often associated with hemorrhagic complications. Safety of dasatinib after thrombolytic therapy in acute ischemic stroke is unknown. Case Description: A 63-year-old man with multiple vascular risk factors and chronic myelogenous leukemia (in molecular remission) on dasatinib presented with signs and symptoms of right hemispheric stroke owing to acute intracranial internal carotid artery occlusion that was treated with intravenous thrombolysis and mechanical thrombectomy resulting in near-complete resolution of stroke symptoms. The patient developed clinical worsening (>24 hours of thrombolytic therapy) after receiving a second dose of dasatinib that was due to symptomatic intracerebral hemorrhage and necessitated decompressive hemicraniectomy. Routine coagulation profile was normal. The etiology of this hemorrhagic complication was likely secondary to primary platelet dysfunction due to dasatinib as reported in some recent in vitro and ex vivo studies. Conclusions: It is advisable to withhold dasatinib during the poststroke period owing to its associated risk of symptomatic intracerebral hemorrhage.
AB - Background: Dasatinib, a tyrosine kinase inhibitor commonly used in treatment of acute lymphoblastic leukemia and chronic myelogenous leukemia, is often associated with hemorrhagic complications. Safety of dasatinib after thrombolytic therapy in acute ischemic stroke is unknown. Case Description: A 63-year-old man with multiple vascular risk factors and chronic myelogenous leukemia (in molecular remission) on dasatinib presented with signs and symptoms of right hemispheric stroke owing to acute intracranial internal carotid artery occlusion that was treated with intravenous thrombolysis and mechanical thrombectomy resulting in near-complete resolution of stroke symptoms. The patient developed clinical worsening (>24 hours of thrombolytic therapy) after receiving a second dose of dasatinib that was due to symptomatic intracerebral hemorrhage and necessitated decompressive hemicraniectomy. Routine coagulation profile was normal. The etiology of this hemorrhagic complication was likely secondary to primary platelet dysfunction due to dasatinib as reported in some recent in vitro and ex vivo studies. Conclusions: It is advisable to withhold dasatinib during the poststroke period owing to its associated risk of symptomatic intracerebral hemorrhage.
KW - Acute ischemic stroke
KW - Dasatinib
KW - Symptomatic intracranial hemorrhage
KW - Thrombolytic therapy
KW - Tissue plasminogen activator
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U2 - 10.1016/j.wneu.2019.02.026
DO - 10.1016/j.wneu.2019.02.026
M3 - Article
C2 - 30797908
AN - SCOPUS:85062893353
SN - 1878-8750
VL - 125
SP - 383
EP - 386
JO - World Neurosurgery
JF - World Neurosurgery
ER -