The Effect of Treatment with tPA on Factor VIII Elevation

Factor VIII (FVIII), an integral part of the clotting process, has been associated with increased incidence of acute ischemic stroke (AIS) when elevated. Intravenous tissue plasminogen activator (IV tPA) is a clot-busting drug and is the only FDA approved treatment for AIS. The effect of IV tPA on FVIII levels has not yet been explored in the context of ischemic stroke. This case report will examine three unique cases and the effect of IV tPA administration on severely elevated FVIII levels. In case 1, the FVIII level decreases steadily to normal levels, post-tPA administration. In case 2, the FVIII level decreases dramatically in the acute phase post-tPA and then rises steadily to near-baseline level. Finally, in case 3, the FVIII level increases post-tPA and then remains consistently elevated for the duration of the acute phase. The purpose of this case report is to explore the potential relationship between IV tPA and FVIII levels with respect to recanalization and post-stroke level of functioning.