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Bleeding Risk With Ischemic Stroke Therapy

Stefan Kiechl, MD; Michael Knoflach, MD; Johann Willeit, MD
JAMA. 2012;308(13):1318. doi:10.1001/2012.jama.11661.
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To the Editor: Within a period of only 2 months, 3 articles13 have been published on bleeding risk among patients with stroke who were treated with warfarin and intravenous thrombolysis, highlighting the scientific controversies and clinical uncertainties related to this issue. A heightened risk of symptomatic intracerebral hemorrhage (sICH) was demonstrated in a single-center patient series with high-quality ascertainment of warfarin intake1 and in 2 meta-analyses,1,2 whereas Dr Xian and colleagues3 reported a null association. The latter evaluation3 represents the largest experience on the safety of thrombolysis in patients with acute stroke treated with warfarin, but difference in sample size is unlikely to fully explain the discrepancy among the studies. Differences in methods and patient enrollment deserve consideration.

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