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Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke: a systematic review and meta-analysis

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Abstract

Since there are contradictory data regarding the association of antiplatelet pretreatment (AP) with safety and efficacy outcomes of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), we conducted a systematic review and meta-analysis of available randomized-controlled clinical trials (RCTs) to investigate the association of AP with outcomes of AIS patients treated with intravenous alteplase. The outcome events of interest included symptomatic intracranial hemorrhage (sICH), fatal ICH, complete recanalization (CR), 3-month favorable functional outcome (FFO, mRS score 0–1), 3-month functional independence (FI, mRS score 0–2), and mortality. The corresponding odds ratios (ORs) were calculated for all the outcome events using random-effects model. The adjusted age and admission NIHSS OR (ORadjusted) were also estimated for all available outcomes. We included 7 RCTs (4376 patients, 33.7% with AP). In unadjusted analyses, AP was associated with higher likelihood of sICH (OR = 1.89, 95% CI 1.40–2.56), death (OR = 1.59, 95% CI 1.24–2.03), and lower likelihood of 3-month FI (OR = 0.69, 95% CI 0.56–0.85). No association was detected between AP and fatal ICH (OR = 1.53, 95% CI 0.75–3.15), 3-month FFO (OR = 0.79, 95% CI 0.58–1.07), and CR (OR = 0.64, 95% CI 0.04–11.66). After adjustment for age and admission stroke severity, AP was not related to sICH (ORadjusted = 1.67, 95% CI 0.75–3.72), 3-month FI (ORadjusted = 0.88, 95% CI 0.54–1.42), or death (ORadjusted = 1.01, 95% CI 0.55–1.86) in adjusted analyses. In conclusion, after adjusting for confounders, AP was not associated with a higher risk of sICH and worse 3-month functional outcome in AIS treated with intravenous alteplase. Antiplatelet intake prior to tPA-bolus should not be used as a reason to withhold or lower alteplase dose in AIS patients treated with IVT.

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Authors and Affiliations

  1. Second Department of Neurology, “Attikon University Hospital”, School of Medicine, National and Kapodistrian University of Athens, Iras 39, Gerakas Attikis, Athens, 15344, Greece

    Georgios Tsivgoulis & Aristeidis H. Katsanos

  2. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Georgios Tsivgoulis, Ramin Zand, Anne W. Alexandrov & Andrei V. Alexandrov

  3. Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece

    Aristeidis H. Katsanos & Sotirios Giannopoulos

  4. Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Vijay K. Sharma

  5. Department of Neurology, Universitätsklinikum Essen, Essen, Germany

    Martin Köhrmann

  6. Department of Neurology, University Hospital of Larissa, Larissa, Greece

    Efthymios Dardiotis

  7. Australian Catholic University, Sydney, Australia

    Anne W. Alexandrov

  8. Department of Neurology, Henry Ford Hospital, Detroit, MI, USA

    Panayiotis D. Mitsias

  9. Department of Neurology, School of Medicine, University of Crete, Crete, Greece

    Panayiotis D. Mitsias

  10. Departments of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Minden, Germany

    Peter D. Schellinger

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  1. Georgios Tsivgoulis
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  2. Aristeidis H. Katsanos
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  3. Ramin Zand
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  6. Sotirios Giannopoulos
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  7. Efthymios Dardiotis
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  8. Anne W. Alexandrov
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  9. Panayiotis D. Mitsias
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  10. Peter D. Schellinger
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  11. Andrei V. Alexandrov
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Contributions

Conception and design of the study: GT, AHK, PDS, and AVA. Acquisition of data: GT and AHK. Analysis of data: GT and AHK. Drafting the manuscript: GT, AHK, RZ, VKS, MK, SG, ED, AWA, PDM, PDS, and AVA.

Corresponding author

Correspondence to Georgios Tsivgoulis.

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The authors declare that they have no competing interests.

Sources of funding

Dr. Georgios Tsivgoulis has been supported by European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

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Tsivgoulis, G., Katsanos, A.H., Zand, R. et al. Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke: a systematic review and meta-analysis. J Neurol 264, 1227–1235 (2017). https://doi.org/10.1007/s00415-017-8520-1

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  • DOI: https://doi.org/10.1007/s00415-017-8520-1

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