Safety of antiplatelet therapy prior to intravenous thrombolysis in acute ischemic stroke.
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.


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Uyttenboogaart
Maarten
M
Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.uyttenboogaart@neuro.umcg.nl
Koch
Marcus W
MW
Koopman
Karen
K
Vroomen
Patrick C A J
PC
De Keyser
Jacques
J
Luijckx
Gert-Jan
GJ
D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D015984:Causality; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator