Systemic thrombolysis in ischemic stroke after recent oral surgery and management of oral cavity bleeding

Thrombolysis with recombinant tissue plasminogen activator in the treatment of acute ischemic stroke carries a long list of contraindications. One of these is recent surgery, but the extent of complications after minor surgeries such as dental extraction or oral surgical procedures is unclear. Here, we report the management of 2 cases with accidental bleeding from the oral cavity during systemic thrombolysis in ischemic stroke because of recent unreported oral surgery. Bleeding at the operation site occurred early and was stopped by prompt discontinuation of the recombinant tissue plasminogen activator infusion and local compressive therapy. Patients and relatives may not be aware that surgical procedures within the oral cavity are regarded as minor surgery and should be explicitly asked during the evaluation of ischemic stroke within the period for thrombolysis.