Acetylsalicylic Acid Pretreatment, Concomitant Heparin Therapy and the Risk of Early Intracranial Hemorrhage following Systemic Thrombolysis for Acute Ischemic Stroke

Abstract

Background: The risk of intracerebral hemorrhage in systemic thrombolysis for acute ischemic stroke after acetylsalicylic acid (ASA) pretreatment or with subsequent heparin is controversially discussed. Methods: 300 consecutive stroke patients were treated with recombinant tissue-type plasminogen activator (rt-PA) in a prospective open study (92 pretreated with ASA, 202 ASA nonusers) with 3 months of follow-up. After thrombolysis, 122 patients received low-dose, 153 patients high-dose heparin. Results: Logistic regression analysis showed no relationship of hemorrhagic complications within the first 48 h to ASA pretreatment (p = 0.15), or heparin application (p = 0.38), but dependency on stroke severity (NIHSS) at baseline (p = 0.01). Conclusion: ASA pretreatment does not increase the risk of symptomatic bleeding after systemic thrombolysis with rt-PA, even if thrombolysis is followed by anticoagulation.

Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Receiving Antiplatelet Therapy: A Systematic Review and Meta‐analysis of 19 Studies

“…The outcomes of study quality assessment are as follows: 8 studies scored 9 (Xian et al,29 Pan et al,25 Meurer et al,24 Ibrahim et al,20 Dorado et al,19 Diedler et al,18 Cucchiara et al,16 and Uyttenboogaart et al13), 3 studies scored 8 (Bluhmki et al,15 Bravo et al,12 and Tanne et al9), and 7 studies scored 7 (Meseguer et al,27 Watson‐Fargie et al,28 Lindley et al,26 Martí‐Fàbregas et al,11 Schmülling et al,10 Šaňák et al,21 and Hermann et al17). Those scores served as differentiators in a subgroup analysis that divided studies into 2 groups (NOS >7 and NOS ≤7).…”

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

“…Intravenous heparin has been administered after administration of intravenous rtPA. 633,634 No increase in bleeding complications was reported. Heparin has been given in addition to abciximab with a reasonable degree of safety 635 ; however, neither the safety nor efficacy of adjunctive anticoagulation has been established, and additional research is required.…”

Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Receiving Antiplatelet Therapy at Stroke Onset

“…Whereas several reports provided data on safety of thrombolysis in patients under treatment with ASA, 10,[12][13][14] only limited data from large series of patients on pretreatment with CLP or the combination of ASA and DP or ASA and CLP have been available so far. 16 However, previous secondary prevention studies pointed toward an increased bleeding risk for the combination therapy of ASA and CLP.…”

“…Although some studies found that ASA 10,11 increases the risk for SICH, others do not report an association between ASA comedication at stroke onset and the incidence of SICH. [12][13][14] The recently published multivariable analysis of SITS-MOST (Safe Implementation of Treatments in Stroke-Monitoring Study) data 15 revealed that patients receiving ASA at stroke onset had a significantly higher rate of SICH per SITS-MOST definition but not per the National Institute of Neurological Disorders and Stroke (NINDS) definition.…”