TY - JOUR
TI - Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke
AU - Tsivgoulis, G.
AU - Goyal, N.
AU - Kerro, A.
AU - Katsanos, A.H.
AU - Krishnan, R.
AU - Malhotra, K.
AU - Pandhi, A.
AU - Duden, P.
AU - Deep, A.
AU - Shahripour, R.B.
AU - Bryndziar, T.
AU - Nearing, K.
AU - Chulpayev, B.
AU - Chang, J.
AU - Zand, R.
AU - Alexandrov, A.W.
AU - Alexandrov, A.V.
JO - Functional Neurology
PY - 2018
VL - 91
TODO - 11
SP - e1067-e1076
PB - NLM (Medline)
SN - null
TODO - 10.1212/WNL.0000000000006168
TODO - acetylsalicylic acid;  antithrombocytic agent;  clopidogrel, aged;  brain hemorrhage;  cerebrovascular accident;  clinical trial;  combination drug therapy;  controlled clinical trial;  controlled study;  female;  fibrinolytic therapy;  human;  intravenous drug administration;  male;  middle aged;  mortality;  multicenter study;  prospective study;  statistics and numerical data;  time factor;  treatment outcome;  United States, Administration, Intravenous;  Aged;  Aspirin;  Clopidogrel;  Drug Therapy, Combination;  Female;  Humans;  Intracranial Hemorrhages;  Male;  Middle Aged;  Platelet Aggregation Inhibitors;  Prospective Studies;  Stroke;  Thrombolytic Therapy;  Time Factors;  Treatment Outcome;  United States
TODO - OBJECTIVE: We sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study. METHODS: We compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality. RESULTS: Among 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes. CONCLUSIONS: DAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk. © 2018 American Academy of Neurology.
ER -