| Safety of intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy at stroke onset. | |
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MedLine Citation:
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PMID: 20056933 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Antiplatelets (APs) may increase the risk of symptomatic intracerebral hemorrhage (ICH) following intravenous thrombolysis after ischemic stroke. METHODS: We assessed the safety of thrombolysis under APs in 11,865 patients compliant with the European license criteria and recorded between 2002 and 2007 in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register (SITS-ISTR). Outcome measures of univariable and multivariable analyses included symptomatic ICH (SICH) per SITS Monitoring Study (SITS-MOST [deterioration in National Institutes of Health Stroke Scale >or=4 plus ICH type 2 within 24 hours]), per European Cooperative Acute Stroke Study II (ECASS II [deterioration in National Institutes of Health Stroke Scale >or=4 plus any ICH]), functional outcome at 3 months and mortality. RESULTS: A total of 3782 (31.9%) patients had received 1 or 2 AP drugs at baseline: 3016 (25.4%) acetylsalicylic acid (ASA), 243 (2.0%) clopidogrel, 175 (1.5%) ASA and dipyridamole, 151 (1.3%) ASA and clopidogrel, and 197 (1.7%) others. Patients receiving APs were 5 years older and had more risk factors than AP na?ve patients. Incidences of SICH per SITS-MOST (ECASS II respectively) were as follows: 1.1% (4.1%) AP na?ve, 2.5% (6.2%) any AP, 2.5% (5.9%) ASA, 1.7% (4.2%) clopidogrel, 2.3% (5.9%) ASA and dipyridamole, and 4.1% (13.4%) ASA and clopidogrel. In multivariable analyses, the combination of ASA and clopidogrel was associated with increased risk for SICH per ECASS II (odds ratio, 2.11; 95% CI, 1.29 to 3.45; P=0.003). However, we found no significant increase in the risk for mortality or poor functional outcome, irrespective of the AP subgroup or SICH definition. CONCLUSIONS: The absolute excess of SICH of 1.4% (2.1%) in the pooled AP group is small compared with the benefit of thrombolysis seen in randomized trials. Although caution is warranted in patients receiving the combination of ASA and clopidogrel, AP treatment should not be considered a contraindication to thrombolysis. |
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Authors:
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Jennifer Diedler; Niaz Ahmed; Marek Sykora; Maarten Uyttenboogaart; Karsten Overgaard; Gert-Jan Luijckx; Lauri Soinne; Gary A Ford; Kennedy R Lees; Nils Wahlgren; Peter Ringleb |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-01-07 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-26 Completed Date: 2010-02-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 288-94 Citation Subset: IM |
Affiliation:
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Department of Neurology, University of Heidelberg, Heidelberg, Germany. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease
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epidemiology,
therapy Adolescent Adult Aged Aged, 80 and over Aspirin / administration & dosage, adverse effects, contraindications Brain Ischemia / drug therapy*, physiopathology, prevention & control Cerebral Hemorrhage / chemically induced*, epidemiology*, physiopathology Dipyridamole / administration & dosage, adverse effects, contraindications Drug Incompatibility Drug Therapy, Combination / adverse effects, methods Drug Toxicity Female Fibrinolytic Agents / administration & dosage, adverse effects, contraindications Humans Incidence Injections, Intravenous / adverse effects, statistics & numerical data Male Middle Aged Platelet Aggregation Inhibitors / administration & dosage, adverse effects*, contraindications Risk Assessment Stroke / drug therapy*, physiopathology, prevention & control Ticlopidine / administration & dosage, adverse effects, analogs & derivatives, contraindications Tissue Plasminogen Activator / administration & dosage, adverse effects*, contraindications Treatment Outcome Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 58-32-2/Dipyridamole; 90055-48-4/clopidogrel; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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