title: Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?
abstract: BACKGROUND
  Symptomatic intracerebral hemorrhage (sICH) after bridging thrombolysis for acute ischemic stroke is a devastating complication. We aimed to assess whether the additional administration of aspirin during endovascular intervention increases bleeding rates.
  
  
  METHODS
  We retrospectively compared bleeding complications and outcome in stroke patients who received bridging thrombolysis with (tPA+ASA) and without (tPA-ASA) aspirin during endovascular intervention between November 2008 and March 2014. Furthermore, we analyzed bleeding complications and outcome in antiplatelet naïve patients with those with prior or acute antiplatelet therapy.
  
  
  RESULTS
  Baseline characteristics, previous medication, and dosage of rtPA did not differ between 50 tPA+ASA (39 aspirin naïve, 11 preloaded) and 181 tPA-ASA patients (p>0.05). tPA+ASA patients had more often internal carotid artery (ICA) occlusion (p<0.001), large artery disease (p<0.001) and received more often acute stenting of the ICA (p<0.001). 10/180 (5.6%) tPA-ASA patients and 3/49 (6.1%) tPA+ASA patients suffered a sICH (p = 1.0). Rates of asymptomatic intracerebral hemorrhage, systemic bleeding complications and outcome did not differ between both groups (p>0.1). There were no differences in bleeding complications and mortality among 112 bridging patients with antiplatelet therapy (62 preloaded, 39 acute administration, 11 both) and 117 antiplatelet naïve patients. In a logistic regression analysis, aspirin administration during endovascular procedure was not a predictor of sICH.
  
  
  CONCLUSIONS
  Antiplatelet therapy before or during bridging thrombolysis in patients with acute ischemic stroke did not increase the risk of bleeding complications and had no impact on outcome. This finding has to be confirmed in larger studies.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0002-8454-3680
authors.initials: A
authors.lastname: Broeg-Morvay
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Slezak
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Kai
authors.initials: K
authors.lastname: Liesirova
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Meisterernst
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.|Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D015912:Thrombolytic Therapy
chemical_list: D010975:Platelet Aggregation Inhibitors