Emergent loading dose of antiplatelets for stenting after IV rt-PA in acute ischemic stroke: a feasibility study

Han, Yaling; Dai, Qiliang; Chen, Xiangliang; Xiong, Yunyun; Yin, Qin; Xu, Gelin; Zhu, Wusheng; Zhang, Renliang; Ma, Minmin; Liu, Wenhua; Liu, Xinfeng

doi:10.1080/00207454.2017.1367295

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…13) Han et al also report a series of AIS patients receiving an emergent loading dose of antiplatelets (aspirin 300 mg and clopidogrel 300 mg) with acute stenting after tPA, finding a low rate of rate of hemorrhagic transformation (1/12 or 8.3%) with this protocol. 20) Our data contribute to this literature, supporting the potential safety of early antiplatelet administration after tPA in selected AIS patients.…”

Section: Discussionsupporting

confidence: 76%

Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke

Brandel

Elsawaf

Rennert

et al. 2020

J Cerebrovasc Endovasc Neurosurg

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Objective: Although stroke guidelines recommend antiplatelets be started 24 hoursafter tissue plasminogen activator (tPA), select mechanical thrombectomy (MT)patients with luminal irregularities or underlying intracranial atherosclerotic diseasemay benefit from earlier antiplatelet administration.Methods: We explore the safety of early (< 24 hours) post-tPA antiplatelet use byretrospectively reviewing patients who underwent MT and stent placement for acuteischemic stroke from June 2015 to April 2018 at our institution.Results: Six patients met inclusion criteria. Median presenting and pre-operativeNational Institutes of Health Stroke Scale scores were 14 (Interquartile Range [IQR]5.5-17.3) and 16 (IQR 13.7-18.7), respectively. Five patients received standard intravenous(IV) tPA and one patient received intra-arterial tPA. Median time from symptomonset to IV tPA was 120 min (IQR 78-204 min). Median time between tPA and antiplateletadministration was 4.9 hours (IQR 3.0-6.7 hours). Clots were successfullyremoved from the internal carotid artery (ICA) or middle cerebral artery (MCA) in 5patients, the anterior cerebral artery (ACA) in one patient, and the vertebrobasilarjunction in one patient. All patients underwent MT before stenting and achievedthrombolysis in cerebral infarction 2B recanalization. Stents were placed in the ICA(n=4), common carotid artery (n=1), and basilar artery (n=1). The median time fromstroke onset to endovascular access was 185 min (IQR 136-417 min). No patientsexperienced symptomatic post-procedure intracranial hemorrhage (ICH). Medianmodified Rankin Scale score on discharge was 3.5.Conclusions: Antiplatelets within 24 hours of tPA did not result in symptomatic ICHin this series. The safety and efficacy of early antiplatelet administration after tPA inselect patients following mechanical thrombectomy warrants further study.

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Section: Discussionsupporting

confidence: 76%

Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke

Brandel

Elsawaf

Rennert

et al. 2020

J Cerebrovasc Endovasc Neurosurg

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“…In addition, there have been multiple recent reports proposing the option of acute stenting on tPA with follow-up ASA/Plavix loading; however, the supporting data are greatly underpowered, with the largest series reporting on 12 patients. [3,6,24] Further investigation may establish the safety and feasibility of this option and should be explored.…”

Section: Discussionmentioning

confidence: 99%

Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?

Elder

Verhey

Schultz

et al. 2022

Surgical Neurology International

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Background: Acute ischemic stroke (AIS) due to cervical internal carotid artery (cICA) occlusion is challenging to treat, with the lower revascularization rates, higher risk for complications, and poor response to thrombolytic therapy compared to isolated intracranial occlusions. While emergent revascularization through mechanical thrombectomy (MT) improves outcomes, the impact of tissue plasminogen activator (tPA) on outcomes in this subgroup of patients remains unclear. The objective of this study is to report our preliminary experience in treating AIS with cICA occlusions secondary to severe atherosclerotic stenosis and to establish the need for further clinical studies to determine the optimal intervention strategy for these lesions. Methods: Data were collected on patients who presented with acute cICA occlusion who underwent MT and either acute or staged carotid angioplasty and stenting. We compare patients who received tPA to those who did not, analyzing revascularization times, outcomes, and complications between the two populations, and discuss how this influenced our preferred treatment approach. Results: Twenty-one patients met inclusion criteria, seven of who received tPA and 14 did not receive tPA before surgical intervention. Procedural and functional outcomes were similar between the two populations. TPA administration correlated with a higher rate of vessel reocclusion in staged procedures and trended toward higher rates of symptomatic ICH and 90-day mortality. Conclusion: Emergent revascularization with acute cICA stenting carries advantages, but its safety is precluded by tPA administration. We suggest a trial which randomizes patients with cICA occlusions to receiving either tPA or dual antiplatelet therapy before surgical intervention, aiming to ultimately improved outcomes in these patients.

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“…The combined application of loading doses of clopidogrel and aspirin was studied in a non-thrombolytic population with cerebral infarction [17] and a bridging treatment population after thrombolysis. [18] The results showed that the loading doses of dual antiplatelet drugs could accelerate the inhibition of platelet aggregation with better therapeutic effects and no decrease in safety. These studies also lead us to propose a scientific hypothesis that, on the basis of using a lower dose of 0.6 mg/kg rt-PA to improve the safety of thrombolysis to a certain extent, administering a loaded dose of dual antiplatelet drugs may be more beneficial for improving the prognosis of Asian patients and reducing the rate of vascular re-occlusion after thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of short-term high dosage dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke

Chen,

Lin,

et al. 2023

Medicine

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Objective: To evaluate the efficacy and safety of short-term high-dose of dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke (AIS). Methods: All 208 patients with AIS were randomized into group 1 (103 cases, after 0.6 mg/kg rt-PA, 300 mg of oral aspirin(ASP) q.d. and 225 mg of oral clopidogrel (CLO) q.d. for for 5 days, then 100 mg of oral ASP q.d. for the next 85 days and 75 mg of oral CLO q.d. for the next 16 days) and group 2 (105 cases, after 0.9 mg/kg rt-PA, 100 mg of oral ASP q.d. for 90 days and 75 mg of oral CLO q.d. for 21 days).The efficacy index was the mRS score, NIHSS score and recurrence risk of stroke, while the safety index was the incidence of bleeding events and mortality. All parameters were evaluated at 30 and 90 days after thrombolysis. Patients whose characteristics may provide the best treatment benefit were further analyzed using the logistic regression model in group 1. Results: The proportion of mRS scores between 0 and 1 in group 1 was higher than that in group 2 at both 30 days (44.7% vs 32.4%, P < .05) and 90 days (50.5% vs 35.2%, P < .05). Compared to group 2, the proportion of NIHSS scores less than 4 was significantly higher in group 1 at both 30 days (37.9% vs 25.7%, P < .05) and 90 days (46.6% vs 30.5%, P < .05). At 90 days, Group 1 had a lower stroke recurrence risk than Group 2 (3.9% vs 10.5%, P < .05). The incidence of SICH was significantly different between the 2 groups at both 30 days (2.9% vs 9.5%, P < .05) and 90 days (2.9% vs 10.5%, P < .05). However, other bleeding events and mortality rates were not significantly different between the 2 groups. The lower the baseline NIHSS score and the shorter the OTT, the more favorable the outcomes obtained at 90 days. Conclusions: Compared to standard doses, short term high-dose dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis may be a good choice for AIS patients.

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Emergent loading dose of antiplatelets for stenting after IV rt-PA in acute ischemic stroke: a feasibility study

Abstract: Our finding preliminary suggested that an emergent loading dose of antiplatelets may be safe and feasible for acute stenting after IV rt-PA.

Cited by 6 publications

References 27 publications

Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke

Antiplatelet therapy within 24 hours of tPA: lessons learned from patients requiring combined thrombectomy and stenting for acute ischemic stroke

Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?

Efficacy and safety of short-term high dosage dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke

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