Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke
| Autor: | Tomas Bryndziar, Anne W. Alexandrov, Ramin Zand, Boris Chulpayev, Georgios Tsivgoulis, Peter Duden, Aristeidis H. Katsanos, Katherine Nearing, Reza Bavarsad Shahripour, Jason J. Chang, Aman Deep, Abhi Pandhi, Ali Kerro, Andrei V. Alexandrov, Rashi Krishnan, K Malhotra, Nitin Goyal |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Asymptomatic 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Internal medicine Humans Medicine Thrombolytic Therapy Prospective Studies Prospective cohort study Stroke Aged Aspirin business.industry Confounding Odds ratio Middle Aged medicine.disease United States Confidence interval Clopidogrel Treatment Outcome Propensity score matching Administration Intravenous Drug Therapy Combination Female Neurology (clinical) medicine.symptom business Intracranial Hemorrhages Platelet Aggregation Inhibitors 030217 neurology & neurosurgery |
| Zdroj: | Neurology. 91:e1067-e1076 |
| ISSN: | 1526-632X 0028-3878 |
| Popis: | ObjectiveWe sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study.MethodsWe compared the following outcomes between DAPP+ and DAPP− IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0–1), and 3-month mortality.ResultsAmong 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP− patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47–8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06–5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP− patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes.ConclusionsDAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates.Classification of evidenceThis study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|