Safety of intravenous thrombolysis in cerebral microbleeds patients with prior antiplatelet therapy.
- Author:
Shen-qiang YAN
1
;
Ying-ying MAO
1
;
Gen-long ZHONG
1
;
Sheng ZHANG
1
;
Min LOU
1
Author Information
- Publication Type:Journal Article
- MeSH: Aged; Brain Ischemia; drug therapy; Cerebral Hemorrhage; drug therapy; Female; Humans; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Recombinant Proteins; administration & dosage; therapeutic use; Stroke; drug therapy; Thrombolytic Therapy; Tissue Plasminogen Activator; administration & dosage; therapeutic use; United States
- From: Journal of Zhejiang University. Medical sciences 2015;44(6):618-624
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo evaluate the safety of intravenous thrombolysis (IVT) in cerebral microbleeds (CMBs) patients with prior antiplatelet therapy.
METHODSFour hundred and forty nine patients with acute ischemic stroke aged (66.8 ± 12.9) years, including 298 males and 151 females, underwent susceptibility-weighted imaging (SWI) examination and MRI-guided IVT therapy between June 2009 and June 2015. The presence of CMBs, previous antiplatelet therapy, HT subtypes according to ECASS II criteria and functional outcome based on modified Rankin scale (mRS) at 3 months were analyzed in logistic regression model.
RESULTSTotal 934 CMBs were detected in 172 (38.3%) patients, among whom 63 (14.0%) previously received antiplatelet therapy. All patients received intravenous recombinant tissue-plasminogen activator (rt-PA) for thrombolysis with the onset-to needle time of (229.0 ± 103.7) min. The pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 10 (IQR 5-15). Logistic regression analysis indicated that prior antiplatelet use increased neither risk of parenchymal hematoma (PH) (OR=0.809,95% CI:0.201-3.262, P=0.766) nor adverse functional outcome (OR=1.517, 95% CI:0.504-4.568, P=0.459) in patients with CMBs; while in patients with multiple CMBs (≥ 3) prior antiplatelet use increased risk of hemorrhagic transformation (OR=9.737, 95% CI: 1.364-69.494, P=0.023), but not adverse functional outcome (OR=1.697, 95% CI:0.275-10.487, P=0.569).
CONCLUSIONThe study indicates that in patients with CMBs, thrombolytic therapy should not be excluded due to the prior use of antiplatelet; however, the larger prospective studies are needed in future for patients with multiple CMBs.
