Highlights
- •Limited data available on the effect of prior antiplatelet use on safety and functional outcome of stroke patients who receive IV thrombolysis.
- •Our data is from a large volume comprehensive stroke center in the United States.
- •No significant association shown between the risk of symptomatic ICH and good functional outcome after IV thrombolysis for stroke patients on antiplatelet therapy (dual or single) in comparison with antiplatelet naïve patients.
Abstract
Aim
To study the effects of pretreatment with Antiplatelet (AP) before IV thrombolysis
(IVT) on the rate of symptomatic intracranial hemorrhage (sICH) and functional outcome
in patients with Acute Ischemic stroke (AIS).
Method
In this retrospective study, the medical records and cerebrovascular images of all
the patients who received IVT for AIS in our center in a 9.6-year period were reviewed.
Patients who took at least one dose of any APs in the last 24 h prior to IVT were
identified. They were categorized according to the type of AP, single versus dual
AP therapy (DAPT), and dose of AP. Rate of sICH and functional outcome at discharge
were compared between the AP users and non-users.
Results
A total of 834 patients received IVT for AIS in our center during a 9.6- year period.
Multivariate models were adjusted for age, NIHSS on admission, history of atrial fibrillation,
history of hypertension, INR on admission, history of stroke and diabetes mellitus.
In multivariate regression analyses and after adjusting for the variables mentioned
above, the use of any AP was not associated with an increased rate of sICH (OR = 1.28
[0.70–2.34], p = 0.425). Furthermore, the use of DAPT did not significantly increase the rate of
sICH in multivariate regression analyses. (OR = 0.663 [0.15–2.84], p = 0.580). The patients on any AP had a lower chance of having good functional outcome
in univariate analysis (OR = 0.735 [0.552–0.979], p = 0.035). However, when adjusted for age, baseline NIHSS, history of diabetes, hypertension
and prior stroke, AP use was not associated with a decreased chance of having a good
functional outcome at discharge. (OR = 0.967 [0.690–1.357], p = 0.848). In addition, no significant difference was noted in the rate of good functional
outcome between patients on DAPT and no AP users in multivariate regression analyses.
(OR = 1.174 [0.612–2.253], p = 0.629).
Conclusion
Our study did not show any significant association between the risk of sICH and good
functional outcome after IVT for AIS patients on AP therapy (dual or single) in comparison
with AP naïve patients.
Keywords
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Article info
Publication history
Published online: April 15, 2021
Accepted:
April 12,
2021
Received in revised form:
March 18,
2021
Received:
November 13,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
