Outcomes of antiplatelet therapy for haemorrhage patients after thrombolysis: a prospective study based on susceptibility-weighted imaging

Abstract

The authors evaluated the effect of susceptibility-weighted imaging (SWI) for antiplatelet therapy on post-thrombolysis microbleeds (MB). A total of 146 patients without symptomatic intracranial haemorrhage on computed tomography after thrombolysis were allocated to two groups: group A (n=72) received antiplatelets 24h after recombinant tissue plasminogen activator, regardless of SWI-detected haemorrhage; group B (n=74) received antiplatelets for patients without SWI-visualised haemorrhage. Haemorrhage was detected by SWI in 22 and 28 patients in groups A and B, respectively. The difference in mean NIHSS (National Institutes of Health Stroke Scale) score in group A between baseline and 6, 24h, 7, 14days was -1.6, -1.7, -3.6, -5.9, respectively; in group B, the difference in mean NIHSS score between baseline and 6, 24h, 7, 14days was -2.6, -3.3, -5.4, -8.7, respectively. The difference between groups in reduction of mean NIHSS score from baseline was 1.0 (p<0.001) at 6h, 1.6 (p<0.001) at 24h, 1.8 (p=0.001) at 7days and 2.8 (p<0.001) at 14days. NIHSS scores at 7, 14days and modified Rankin scale at 90days were significantly lower in haemorrhage patients in groups B than in A, whereas the hospital stay was shorter and the rate of favourable outcome at 90days was higher. Our results indicated that SWI was an effective approach for the guidance of antiplatelet therapy in post-thrombolysis MB.