Safety and efficacy of early antiplatelet therapy in acute ischemic stroke patients receiving endovascular treatment: A systematic review and meta-analysis

Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial

“…The results of several observational studies that assessed the effects of periprocedural use of antiplatelets during endovascular treatment pointed towards a beneficial effect on functional outcome. 3,4,15 Their antithrombotic effect can reduce thrombotic complications and prevent distal platelet-fibrin occlusive lesions compromising microvascular reperfusion. 16,17 However, our trial showed that periprocedural aspirin increases the risk of symptomatic intracranial haemorrhage and should not be routinely administered during endovascular treatment.…”

“…1,2 Periprocedural anti-thrombotics might enhance angiographic and microvascular reperfusion, and are often used to reduce thrombotic complications. 3,4 However, for aspirin and heparin, the potential benefits are not known on whether its periprocedural use outweigh the potentially increased risk of symptomatic intracranial haemorrhage. 3,5 Guidelines advise against the early administration of aspirin after treatment with intravenous thrombolytics because of its increased risk of sympto matic intracranial haemorrhage without evidence for a beneficial effect in a previous trial.…”

“…Therefore, guidelines provide no recommendations on the periprocedural admin istration of anti-thrombotics and, consequently, large practice variation exists. 4,6,11 In the current study-the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN-MED)we aimed to assess the safety and efficacy of intravenous aspirin, unfractionated heparin, both, or neither started during endovascular treatment in patients with ischaemic stroke due to an intracranial large-vessel occlusion in the anterior circulation.…”

Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion

“…Intravenous tirofiban, a fast-acting non-peptide glycoprotein IIb/IIIa with high selectivity and short half-life, improved the blood flow avoiding another MT. Recently the mounting evidences suggested tirofiban combined with MT is safe and effective [15–18] even before pre-MT is performed [19] . Tirofiban can prevent reocclusion and improve the outcome especially for intracranial artery stenosis related AIS [20,21] .…”

Leukoaraiosis and acute ischemic stroke

“…Thrombolytic therapy is an effective treatment to reduce neurological impairment and improve the survival rate of patients with AIS. Previous studies have demonstrated that following thrombolytic therapy, certain risk factors can cause the occurrence of intracranial haemorrhage (ICH), such as advanced age, diabetes, higher stroke severity, atrial fibrillation, heart disease, renal insufficiency, oral antiplatelet agents, decreased platelet count, increased blood pressure upon admission, signs of early infarction on computed tomography (CT) and specific ethnic origin (Chiang et al, 2020; Emberson et al, 2014; Guo, Lin, et al, 2019; Lansberg et al, 2007; Luo et al, 2016; Whiteley et al, 2012). However, many studies have investigated the relationship between LA and intracranial haemorrhage after thrombolysis, but the results are not consistent.…”