Prestroke Antiplatelet Effect on Symptomatic Intracranial Hemorrhage and Functional Outcome in Intravenous Thrombolysis.
- Author:
Jay Chol CHOI
1
;
Ji Sung LEE
;
Tai Hwan PARK
;
Yong Jin CHO
;
Jong Moo PARK
;
Kyusik KANG
;
Kyung Bok LEE
;
Soo Joo LEE
;
Jae Guk KIM
;
Jun LEE
;
Man Seok PARK
;
Kang Ho CHOI
;
Joon Tae KIM
;
Kyung Ho YU
;
Byung Chul LEE
;
Mi Sun OH
;
Jae Kwan CHA
;
Dae Hyun KIM
;
Hyun Wook NAH
;
Dong Eog KIM
;
Wi Sun RYU
;
Beom Joon KIM
;
Hee Joon BAE
;
Wook Joo KIM
;
Dong Ick SHIN
;
Min Ju YEO
;
Sung Il SOHN
;
Jeong Ho HONG
;
Juneyoung LEE
;
Keun Sik HONG
Author Information
- Publication Type:Original Article
- Keywords: Stroke; Thrombolytic therapy; Platelet aggregation inhibitors; Outcome assessment
- MeSH: Hospital Mortality; Humans; Intracranial Hemorrhages*; Odds Ratio; Platelet Aggregation Inhibitors; Prospective Studies; Risk Factors; Stroke; Thrombolytic Therapy; Tissue Plasminogen Activator
- From:Journal of Stroke 2016;18(3):344-351
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND PURPOSE: 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.
