Abstract
Objective: We assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset. Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register on consecutive IVT-treated AIS patients during a 7-year period (2010–2017). In propensity score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment, we compared: (1) symptomatic intracerebral hemorrhage (SICH), according to SITS Monitoring Study (MOST), European Cooperative Acute Stroke Study (ECASS) II, and National Institute of Neurological Disorders and Stroke (NINDS) definitions; (2) 3-month mortality; (3) 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores = 0–1); (4) 3-month functional independence (FI; mRS scores = 0–2); and (5) distribution of the 3-month mRS scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole, and any other antiplatelet. Results: Propensity score matching resulted in 2 groups of 1,043 patients each, balanced for all baseline characteristics. In the propensity score matched analysis, the 2 groups had comparable (p > 0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS-MOST (2.9% vs 1.5%, 95% confidence interval [CI] = −0.03 to −0.01), ECASS II (5.2% vs 4.4%, 95% CI = −0.03 to 0.01), and NINDS (7.7% vs 6.6%, 95% CI = −0.03 to 0.01) definitions. No differences in the 3-month mortality (17.9% vs 16.6%, 95% CI = −0.05 to 0.02), FFO (45.6% vs 46.0%, 95% CI = −0.04 to 0.05), FI (59.2% vs 60.7%, 95% CI = −0.03 to 0.06), or distribution in 3-month mRS scores (2 [1–4] vs 2 [0–4], 95% CI = −0.29 to 0.09) were documented between the 2 groups. Interpretation: Given that patients on dual antiplatelet pretreatment have similar SICH, 3-month mortality rates, and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients. Ann Neurol 2018;83:89–97.
Original language | English |
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Pages (from-to) | 89-97 |
Number of pages | 9 |
Journal | Annals of Neurology |
Volume | 84 |
Issue number | 1 |
Early online date | 30 Jul 2018 |
DOIs | |
Publication status | Published - Jul 2018 |
Bibliographical note
Funding Information:The current SITS registry is developed, maintained, and upgraded by ZiteLab, Copenhagen, Denmark, in close collaboration with SITS. SITS is financed directly and indirectly by grants from the Karolinska Institute, Stockholm County Council, Swedish Heart-Lung Foundation, Swedish Order of St John, Friends of Karolinska Institute, and private donors, as well as from an unrestricted sponsorship from Boehringer Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority, and Ferrer International. SITS is currently conducting studies supported by Boehringer Ingelheim and EVER Pharma, as well as in collaboration with the Karolinska Institute, supported by Stryker, Covidien, and Phenox. N.A. is supported by grants provided by the Stockholm County Council and Swedish Heart-Lung Foundation. No funding sources had a part in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. We thank all SITS-ISTR investigators and their centers for their participation; and all patients who participated in SITS-ISTR.
Funding Information:
The current SITS registry is developed, maintained, and upgraded by ZiteLab, Copenhagen, Denmark, in close collaboration with SITS. SITS is financed directly and indirectly by grants from the Karolinska Institute, Stockholm County Council, Swedish Heart-Lung Foundation, Swedish Order of St John, Friends of Karolinska Institute, and private donors, as well as from an unrestricted sponsorship from Boehringer Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority, and Ferrer International. SITS is currently conducting studies supported by Boehringer Ingelheim and EVER Pharma, as well as in collaboration with the Karolinska Institute, supported by Stryker, Covidien, and Phenox. N.A. is supported by grants provided by the Stockholm County Council and Swedish Heart-Lung Foundation. No funding sources had a part in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2018 American Neurological Association
Keywords
- acute ischemic stroke
- dual antiplatelet therapy
- mortality
- functional outcome
- intracranial hemorrhage
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Mary MacLeod
- School of Medicine, Medical Sciences & Nutrition, Cardiometabolic Disease
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Medicine - Senior Clinical Lecturer
- School of Medicine, Medical Sciences & Nutrition, Institute of Medical Sciences
Person: Clinical Academic