Document Detail

Safety of intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy at stroke onset.
MedLine Citation:
PMID:  20056933     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-01-07
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-26     Completed Date:  2010-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  288-94     Citation Subset:  IM    
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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MeSH Terms
Acute Disease / epidemiology,  therapy
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
Fibrinolytic Agents / administration & dosage,  adverse effects,  contraindications
Injections, Intravenous / adverse effects,  statistics & numerical data
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
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 58-32-2/Dipyridamole; 90055-48-4/clopidogrel; EC Plasminogen Activator

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