Unexpected coagulation disorders are an infrequent finding in patients with AIS treated with IVT at our center in Santiago, Chile; therefore, blood test results should not be awaited before initiating IVT.
Unexpected coagulation abnormalities were uncommon among 480 stroke patients treated with intravenous thrombolysis at a single Chilean center.
No clinical differences were observed among patients with normal, abnormal, and incomplete/not performed coagulation tests.
Abnormal or incomplete/not performed coagulation testing was significantly less frequent in the Emergency Room during the COVID-19 pandemic.
Among patients with abnormal COT results, INR values and platelet counts differed significantly from the other groups.
Functional outcomes at 3 months, mortality, and symptomatic intracerebral hemorrhage rates did not differ across the coagulation test groups.
The authors conclude that IVT should not be delayed to await blood test results.
This study looked at 480 people who had an ischemic stroke (caused by a blocked brain artery) and received clot-busting medication at one hospital in Santiago, Chile, between 2016 and 2025. Doctors wanted to know how often unexpected blood clotting problems were found, because waiting for blood test results can delay treatment, and every minute matters in stroke care. There was a concern that heavy alcohol use in the region might cause hidden liver disease that affects clotting. Most patients (about 93%) had normal clotting tests. Only 9 patients (under 2%) had abnormal results, and for about 5% the tests were incomplete or not done. Patients with abnormal tests did, as expected, have different clotting values (INR and platelet counts), but there were no differences in clinical characteristics, disability at 3 months, death, or brain bleeding related to the treatment among the groups. This research suggests that unexpected clotting problems are rare in stroke patients treated this way at this center, and that starting treatment without waiting for blood test results did not appear to cause worse outcomes here. The findings come from a single center with very few abnormal cases, so they may not apply everywhere.
Brunser A, Mansilla E, Gutierrez M, Ortega L, Cavada G, Mazzon E, et al.. (2026). Unexpected coagulopathy in thrombolyzed stroke: experience from a single center in Chile.. Arquivos de neuro-psiquiatria. https://doi.org/10.1055/s-0046-1829030