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

Abstract

Background and Purpose-Antiplatelets (APs) may increase the risk of symptomatic intracerebral hemorrhage (ICH) following intravenous thrombolysis after ischemic stroke.

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

“…First, in one of the largest studies in this meta‐analysis (Xian et al29), patient functional status was not evaluated on day 90, which is generally recognized as the most appropriate time point for final functional outcome assessment after acute ischemic stroke 39. It can be observed that there existed a significant discrepancy between the findings of this study and the results of the other largest study18 that measured functional outcomes on day 90 (OR 1.16, 95% CI 1.09–1.24 versus OR 1.02, 95% CI 0.97–1.08), which suggested that the impact of prestroke antiplatelet therapy on functional outcomes after thrombolysis might possibly be time dependent. Second, there were obvious differences in the odds of sICH and favorable outcome among patients receiving different prestroke antiplatelet medications.…”

“…For the 2 pairs of studies that analyzed overlapped data from the same registries, we included the latest and those with the largest samples for meta‐analysis 14, 18, 22, 26. The detailed selection process is summarized in Figure 1.…”

“…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).…”

“…Given the number of included sICH cases diagnosed per NINDS criteria was the largest, for the 3 studies that reported multiple sets of data regarding different sICH definitions,18, 25, 28 those based on the NINDS criteria were included for the main analysis. According to the pooled unadjusted OR, preexisting antiplatelet therapy was significantly associated with postthrombolytic sICH (OR 1.70, 95% CI 1.47–1.97) (Figure 2A).…”

Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

“…12 However, they found no significant increase in the risk for mortality or poor functional outcome, irrespective of the Anti-platelet subgroup or Symptomatic intracranial hemorrhage definition. This analysis concluded that the absolute excess of Symptomatic intracranial hemorrhage of 1.4% (2.1%) in the pooled Anti-platelet group is small compared with the benefit of thrombolysis seen in randomized trials.…”