title: Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment.
abstract: OBJECTIVE
  To compare clinical outcomes of patients who received early initiation (<24 hours) of antithrombotics with those who received standard management (antithrombotics administered ≥24 hours).
  
  
  METHODS
  A total of 712 patients who had an acute ischemic stroke and underwent IV or endovascular (intra-arterial [IA]) recanalization between July 2007 and March 2015 were selected from a prospective clinical registry. Antithrombotics were initiated by an individual clinical decision. We systemically gathered information regarding the exact timing of antithrombotic initiation from a database of the electronic barcode medication administration system.
  
  
  RESULTS
  The recanalization treatment cases included in this study comprised 34% (n = 243) IV only, 32% (n = 229) IA only, and 34% (n = 240) combined IV-IA strategies. Antithrombotics were administered within 24 hours in 64% (n = 456) of the patients. Earlier initiation of antithrombotics was associated with decreased odds of having any hemorrhages (adjusted odds ratio 0.56; 95% confidence interval 0.35-0.89), but was not associated with symptomatic hemorrhages (0.85; 0.35-2.10) or modified Rankin Scale scores of 0-1 at 3 months after stroke (1.09; 0.75-1.59). Ultra-early initiation (<12 hours) did not increase the odds of hemorrhagic transformation (0.26; 0.12-0.52). The effects of earlier antithrombotics on the clinical outcomes were not significantly modified by the modality of recanalization treatment.
  
  
  CONCLUSIONS
  In our retrospective analysis of a prospective registry, early antithrombotic (within 24 hours after initiation) administration did not increase hemorrhages after recanalization treatment. Early antithrombotic therapy may be advantageous for a subset of stroke patients despite the current guidelines.
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
authors: Han-Gil
authors: HG
authors: Jeong
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea. Kim.BJ.Stroke@gmail.com sb0516@snu.ac.kr.
authors: Beom Joon
authors: BJ
authors: Kim
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
authors: Mi Hwa
authors: MH
authors: Yang
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
authors: Moon-Ku
authors: MK
authors: Han
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
authors: Hee-Joon
authors: HJ
authors: Bae
authors: From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
authors: Seung-Hoon
authors: SH
authors: Lee
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D016208:Databases, Factual; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors