title: Early deterioration after thrombolysis plus aspirin in acute stroke: a post hoc analysis of the Antiplatelet Therapy in Combination with Recombinant t-PA Thrombolysis in Ischemic Stroke trial.
abstract: OBJECTIVE
  Aspirin early after intravenous thrombolysis in acute ischemic stroke increases the risk of symptomatic intracranial hemorrhage (SICH), without influencing functional outcome at 3 months. The effect of aspirin on early neurological deterioration (END) was explored as a post hoc analysis of the randomized Antiplatelet Therapy in Combination With Recombinant t-PA Thrombolysis in Ischemic Stroke (ARTIS) trial.
  
  
  METHODS
  END, defined as a ≥4 points National Institutes of Health Stroke Scale worsening ≤24 hours after intravenous thrombolysis, was categorized into SICH (ENDSICH) and cerebral ischemia (ENDCI). Multinomial logistic regression was used to assess the effect of aspirin on END.
  
  
  RESULTS
  Of the 640 patients, 31 patients (4.8%) experienced END (14 ENDSICH, 17 ENDCI). Aspirin increased the risk of ENDSICH (odds ratio, 3.73; 95% confidence interval, 1.03-13.49) but not of ENDCI (odds ratio, 1.14; 95% confidence interval, 0.44-3.00). After adjustment for other explanatory variables, the association between aspirin and ENDSICH remained significant.
  
  
  CONCLUSIONS
  In this trial, there is no evidence of an early antithrombotic effect from the addition of aspirin to intravenous thrombolysis in acute ischemic stroke.
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Zinkstok
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands.
authors.forename: Ludo F
authors.initials: LF
authors.lastname: Beenen
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: de Haan
authors.affiliation: From the Departments of Neurology (S.M.Z., Y.B.R.), Radiology (L.F.B., C.B.M., H.A.M.), Biomedical Engineering and Physics (H.A.M.), and the Clinical Research Unit (R.J.d.H.), Academic Medical Center University, Amsterdam, The Netherlands. y.b.roos@amc.uva.nl.
authors.forename: Yvo B
authors.initials: YB
authors.lastname: Roos
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D001241:Aspirin
keywords: aspirin; safety; stroke; thrombolytic therapy