title: Prestroke Antiplatelet Effect on Symptomatic Intracranial Hemorrhage and Functional Outcome in Intravenous Thrombolysis.
abstract: OBJECTIVE
  About 30%-40% of stroke patients are taking antiplatelet at the time of their strokes, which might increase the risk of symptomatic intracranial hemorrhage (SICH) with intravenous tissue plasminogen activator (IV-TPA) therapy. We aimed to assess the effect of prestroke antiplatelet on the SICH risk and functional outcome in Koreans treated with IV-TPA.
  
  
  METHODS
  From a prospective stroke registry, we identified patients treated with IV-TPA between October 2009 and November 2014. Prestroke antiplatelet use was defined as taking antiplatelet within 7 days before the stroke onset. The primary outcome was SICH. Secondary outcomes were discharge modified Rankin Scale (mRS) score and in-hospital mortality.
  
  
  RESULTS
  Of 1,715 patients treated with IV-TPA, 441 (25.7%) were on prestroke antiplatelet. Prestroke antiplatelet users versus non-users were more likely to be older, to have multiple vascular risk factors. Prestroke antiplatelet use was associated with an increased risk of SICH (5.9% vs. 3.0%; adjusted odds ratio [OR] 1.79 [1.05-3.04]). However, at discharge, the two groups did not differ in mRS distribution (adjusted OR 0.90 [0.72-1.14]), mRS 0-1 outcome (34.2% vs. 33.7%; adjusted OR 1.27 [0.94-1.72), mRS 0-2 outcome (52.4% vs. 52.9%; adjusted OR 1.21 [0.90-1.63]), and in-hospital mortality (6.1% vs. 4.2%; adjusted OR 1.19 [0.71-2.01]).
  
  
  CONCLUSIONS
  Despite an increased risk of SICH, prestroke antiplatelet users compared to non-users had comparable functional outcomes and in-hospital mortality with IV-TPA therapy. Our results support the use of IV-TPA in eligible patients taking antiplatelet therapy before their stroke onset.
authors.affiliation: Department of Neurology, Jeju National University, Jeju, Korea.
authors.forename: Jay Chol
authors.initials: JC
authors.lastname: Choi
authors.affiliation: Clinical Research Center, Asan Medical Center, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Daejeon, Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Daejeon, Korea.
authors.forename: Jae Guk
authors.initials: JG
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Kang-Ho
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Mi-Sun
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Hyun-Wook
authors.initials: HW
authors.lastname: Nah
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Dong-Eog
authors.initials: DE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Wi-Sun
authors.initials: WS
authors.lastname: Ryu
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Wook-Joo
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
authors.forename: Dong-Ick
authors.initials: DI
authors.lastname: Shin
authors.affiliation: Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
authors.forename: Min-Ju
authors.initials: MJ
authors.lastname: Yeo
authors.affiliation: Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Sohn
authors.affiliation: Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
keywords: Outcome assessment; Platelet aggregation inhibitors; Stroke; Thrombolytic therapy