Effect of Prior Antiplatelet Therapy on Risk and Type of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke after Intravenous Thrombolysis (P06.240)

Abstract

Objective: To investigate how prior aspirin therapy affected hemorrhagic transformation in acute ischemic stroke patients after intravenous thrombolysis. Background There is conflicting data regarding prior antiplatelet therapy and risk of hemorrhagic transformation of ischemic stroke after intravenous thrombolysis. Our goal was to investigate how prior aspirin therapy affected the incidence and type of hemorrhagic transformation after intravenous thrombolysis. Design/Methods: We conducted a retrospective study of consecutively enrolled acute ischemic stroke patients at one hospital who received intravenous thrombolysis with recombinant tissue Plasminogen Activator (rt-PA) over a 5 year period between 2005 and 2011. Baseline characteristics including age, gender and prior antiplatelet therapy were registered on admission. Using computerized tomography (CT) scan we identified the patients with hemorrhagic transformation of ischemic stroke after intravenous rt-PA and classified them into hematomas or petechial hemorrhages. Results: We identified 119 patients at our institution with acute ischemic stroke who had received intravenous rt-PA. The mean age was 74.2 years and 46% were male. Of the 119 patients, 27 had hemorrhagic transformation (23%), out of which 16 were hematomas (59%) and 11 were petechial hemorrhages (41%). Of a total of 41 patients on prior Aspirin therapy, 10 had hemorrhagic transformation (24%), 9 of which were hematomas (90%). Of a total of 58 patients on no prior antiplatelet therapy, 16 had hemorrhagic transformation (28%), of which 7 were hematomas (44%). Three patients were on dual antiplatelet therapy with Aspirin and Plavix, none of which had hemorrhagic transformation. Conclusions: In our retrospective study, we found similar rates of hemorrhage between the aspirin and no aspirin group after administration of intravenous thrombolysis. The aspirin group was, however, associated with a greater percentage of hematomas than petechial hemorrhages when compared to the no aspirin group. More data is needed to determine if aspirin promotes a tendency towards hematoma formation in these patients. Disclosure: Dr. Sonni has nothing to disclose. Dr. Drobnis has nothing to disclose. Dr. Fitzgerald has nothing to disclose. Dr. Hreib has nothing to disclose. Dr. Tilem has nothing to disclose.