Safety of Antiplatelet Therapy Prior to Intravenous Thrombolysis in Acute Ischemic Stroke

Abstract

Background: There is some uncertainty whether prior use of antiplatelet (AP) drugs increases the risk of symptomatic intracerebral hemorrhage (SICH) and influences functional outcome in patients with ischemic stroke treated with intravenous thrombolysis. Objective: To assess whether prior use of AP drugs is related to outcome following intravenous tissue plasminogen activator therapy in patients with ischemic stroke. Design, Setting, and Patients: A single-center prospective observational cohort study of the relation between prior AP therapy, occurrence of SICH, and functional outcome of consecutive patients with ischemic stroke undergoing intravenous thrombolysis with tissue plasminogen activator in a university hospital between April 1, 2002, and November 30, 2006. Main Outcome Measures: The occurrence of SICH and favorable outcome reflecting independence defined as a modified Rankin Scale score of 2 or lower at 3 months. Results: Of the 301 patients who received intravenous tissue plasminogen activator, 89 used AP drugs prior to thrombolysis. Symptomatic intracerebral hemorrhage occurred in 12 patients (13.5%; 95% confidence interval, 7.8%-22.3%) who had received AP drugs and in 6 patients (2.8%; 95% confidence interval, 1.2%-6.2%) without prior AP therapy (P = .001). Multivariate analysis revealed that prior AP therapy was an independent predictor of SICH (odds ratio, 6.0; 95% confidence interval, 2.0-17.1). Nonetheless, prior AP therapy was independently associated with a favorable outcome (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). Conclusion: Despite a higher incidence of SICH, the net benefit of intravenous tissue plasminogen activator therapy for acute ischemic stroke was greater in patients using AP drugs.

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).…”

Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

“…58 Among the other variables which are only sporadically included in the scores, prior antiplatelet treatment does not appear in the scores that predict the outcome of thrombolysis because despite the increase in sICH, its impact on 3-month outcome is either neutral 80 or even borderline positive. 81 Regarding its presence in only 1 sICH score, it should be noted that even among the same study population, different sICH definitions and antiplatelet variables (eg, comparison of specific monotherapies or dual versus no therapy) lead to different results. 80 Last but not least, some scores do include information on prestroke disability and social environment (Tables 2 and 3).…”

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).…”