Τίτλος:
Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tsivgoulis, G.
Goyal, N.
Kerro, A.
Katsanos, A.H.
Krishnan, R.
Malhotra, K.
Pandhi, A.
Duden, P.
Deep, A.
Shahripour, R.B.
Bryndziar, T.
Nearing, K.
Chulpayev, B.
Chang, J.
Zand, R.
Alexandrov, A.W.
Alexandrov, A.V.
Περιοδικό:
Functional Neurology
Λέξεις-κλειδιά:
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
DOI:
10.1212/WNL.0000000000006168
