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What is it about?

Acute myocardial infarction (AMI) within 90 days of acute ischemic stroke (AIS) is a relative exclusion criterion for the receipt of alteplase, and patients with elevated partial thromboplastin times (PTT) were excluded from large stroke trials. There are very few reports of antithrombotic reversal to allow for alteplase administration. We describe a 73-year old male who received alteplase for AIS after undergoing percutaneous coronary intervention (PCI) for NSTEMI, with heparin as part of his antithrombotic PCI regimen. We advocate cautious evaluation for potential reversal of ongoing anticoagulation in severely disabled patients, not eligible for mechanical intervention, to facilitate IV alteplase administration in those who otherwise would have been excluded from definitive AIS treatment.

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