Abstract
Background: This study aimed to investigate the safety and efficacy of single antiplatelet, anticoagulant and Dual Antiplatelet pre-treatment (DAPP) in older, moderate to high severity acute ischemic stroke patients treated with intravenous thrombolysis (IVT).Methods: A prospective cohort study was conducted to monitor the development of symptomatic intracranial hemorrhage (SICH) and functional outcomes at 90 days. Two different dosages of alteplase were used for IVT. Logistic regression models were used for analysis of the safety and efficacy outcomes.Results: A total of 1,156 patients were enrolled and categorized into six groups based on their pre-treatment medications: (1) aspirin (n = 213), (2) clopidogrel (n = 37), (3) DAPP of aspirin + clopidogrel (n= 27), (4) warfarin (n = 44), (5) any of the above pre-medications (n = 331), and (6) none of these medications as controls (n = 825). The DAPP group showed significantly increased SICH by the NINDS (adjusted OR: 4.90, 95% CI 1.28–18.69) and the ECASS II (adjusted OR: 5.09, 95% CI: 1.01–25.68) standards. The aspirin group was found to significantly improve the favorable functional outcome of the modified Rankin Scale (mRS) of 0–1 (adjusted OR: 1.91, 95% CI, 1.31.2.78), but no significance for mRS of 0–2 (adjusted OR: 1.39, 95% CI, 0.97–1.99). The DAPP group also significantly increased mortality (adjusted OR: 4.75, 95% CI: 1.77–12.72). A significant interaction between different dosages for IVT and the functional status was noted. Compared to standard dose, the DAPP group showed higher proportions of disability and mortality with low dose of IVT.Conclusion: For older adults with higher baseline severity of acute ischemic stroke, DAPP may increase the risk of SICH and mortality post IVT. However, DAPP is still not an indication to withdraw IVT and to prescribe low-dose IVT for older adults.
Highlights
A post hoc analysis from the randomized controlled trial (RCT) of Enhanced Control of Hypertension and Thrombolysis Stroke (ENCHANTED) Study [1] indicated a significant interaction between the different doses of intravenous thrombolysis (IVT) and pre-treatment of antiplatelet [2]
The aim of this study was to investigate whether pretreatment with single antiplatelet, warfarin, and dual antiplatelet pre-treatment (DAPP) for acute ischemic stroke patients who were treated with IVT with the following characteristics: [1] older age, [2] moderate to high severity with high National Institute of Health Stroke Scale (NIHSS) score at baseline, and [3] the lowdose alteplase, imposed changed risk of Symptomatic Intracranial Hemorrhage (SICH) and the global functional outcomes
Of the 10 patients, four patients were treated with dipyridamole and six stroke patients were with cilostazol, respectively (Supplementary Table 1)
Summary
A post hoc analysis from the randomized controlled trial (RCT) of Enhanced Control of Hypertension and Thrombolysis Stroke (ENCHANTED) Study [1] indicated a significant interaction between the different doses of intravenous thrombolysis (IVT) and pre-treatment of antiplatelet [2]. Two recent studies by Tsivgoulis et al [7, 8] employed propensity score matching (PSM) to control the imbalance of the confounders between both the groups, with and without DAPP Their results suggest that DAPP caused no significant increase in SICH by most standards except of the SITS-MOST criteria, and no significant improvement in the Favorable Functional Outcome (FFO) [7, 8]. This study aimed to investigate the safety and efficacy of single antiplatelet, anticoagulant and Dual Antiplatelet pre-treatment (DAPP) in older, moderate to high severity acute ischemic stroke patients treated with intravenous thrombolysis (IVT)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
