Influence of Antiplatelet Pre-Treatment on the Risk of Symptomatic Intracranial Haemorrhage after Intravenous Thrombolysis

Abstract

Background: The influence of antiplatelet agents (AP) in the development of a symptomatic intracranial haemorrhage (SICH) after intravenous rt-PA is not well known. We assessed the hypothesis that pre-treatment with AP may increase that risk. Methods: We studied data from consecutive patients with ischaemic stroke treated with intravenous rt-PA within the first 3 h after symptom onset. We recorded the antecedent of any AP therapy previous to thrombolysis. A follow-up CT was performed routinely 24–36 h after the infusion of rt-PA. Intracranial bleeding was categorized according to the criteria of the European Cooperative Acute Stroke Study II (ECASS II) into haemorrhagic infarction type 1 and 2 and parenchymal haemorrhage type 1 and 2. SICH was diagnosed if it was of the parenchymal haemorrhage type, occurred within the first 36 h and was associated with neurological deterioration. Results: Of a total of 605 patients, 137 (22.6%) were pre-treated with AP, most of them (n = 106) with aspirin. Any type of intracranial haemorrhage was observed in 119 patients (19.7%), without differences between the AP (18.4%) and the non-AP (20.2%) groups. Parenchymal haemorrhage was observed in 41 patients (8.5%) and SICH in 26 (4.3%). There was a non-significant rise in the frequency of SICH in the AP group compared with the non-AP group (6.6 vs. 3.6% p = 0.10). Conclusions: Pre-treatment with AP non-significantly increases the risk of SICH and therefore this antecedent should not be a contraindication for intravenous thrombolysis.

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).…”

Risk Factors for Intracranial Hemorrhage in Acute Ischemic Stroke Patients Treated With Recombinant Tissue Plasminogen Activator

“…There are 2 potentially modifiable baseline clinical variables associated with post-rtPA hemorrhage, increased blood glucose, and increased blood pressure. Neither the lowering of blood glucose 29 nor the lowering of blood pressure 30 is associated with less death or disability after acute stroke in completed randomized trials, but it is possible that correction of increased blood pressure or glucose might mitigate the increased risk of ICH with rtPA treatment.…”

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

“…It recommended against starting antiplatelet (mono-or dual-therapy) or glycoprotein IIb/IIIa inhibitors in addition to IV-tPA in isolated AIS cases. Several studies have suggested increased risk of intracranial hemorrhage with the use of antiplatelet, especially dual antiplatelet therapy with IV-tPA, but have not shown to adversely influence clinical outcome (45)(46)(47)(48). The increased risk of intracranial hemorrhage with these antiplatelet is likely balanced by the beneficial effect of increased reperfusion or decreased risk of vessel re-occlusion, and these antiplatelets may not by themselves increase the risk of intracranial hemorrhage but makes one worse if it occurs (47).…”