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

Georgios Tsivgoulis, Aristeidis H. Katsanos, Ramin Zand, Vijay K. Sharma, Martin Köhrmann, Sotirios Giannopoulos, Efthymios Dardiotis, Anne Alexandrov, Panayiotis D. Mitsias, Peter D. Schellinger, Andrei Alexandrov

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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 (OR adjusted ) 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 (OR adjusted  = 1.67, 95% CI 0.75–3.72), 3-month FI (OR adjusted  = 0.88, 95% CI 0.54–1.42), or death (OR adjusted  = 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.

Original languageEnglish (US)
Pages (from-to)1227-1235
Number of pages9
JournalJournal of Neurology
Volume264
Issue number6
DOIs
StatePublished - Jun 1 2017

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Meta-Analysis
Stroke
Odds Ratio
Intracranial Hemorrhages
Tissue Plasminogen Activator
Randomized Controlled Trials
Safety
Mortality

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke : a systematic review and meta-analysis. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Zand, Ramin; Sharma, Vijay K.; Köhrmann, Martin; Giannopoulos, Sotirios; Dardiotis, Efthymios; Alexandrov, Anne; Mitsias, Panayiotis D.; Schellinger, Peter D.; Alexandrov, Andrei.

In: Journal of Neurology, Vol. 264, No. 6, 01.06.2017, p. 1227-1235.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Zand, R, Sharma, VK, Köhrmann, M, Giannopoulos, S, Dardiotis, E, Alexandrov, A, Mitsias, PD, Schellinger, PD & Alexandrov, A 2017, 'Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke: a systematic review and meta-analysis', Journal of Neurology, vol. 264, no. 6, pp. 1227-1235. https://doi.org/10.1007/s00415-017-8520-1
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Zand, Ramin ; Sharma, Vijay K. ; Köhrmann, Martin ; Giannopoulos, Sotirios ; Dardiotis, Efthymios ; Alexandrov, Anne ; Mitsias, Panayiotis D. ; Schellinger, Peter D. ; Alexandrov, Andrei. / Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke : a systematic review and meta-analysis. In: Journal of Neurology. 2017 ; Vol. 264, No. 6. pp. 1227-1235.
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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 (OR adjusted ) 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 (OR adjusted  = 1.67, 95{\%} CI 0.75–3.72), 3-month FI (OR adjusted  = 0.88, 95{\%} CI 0.54–1.42), or death (OR adjusted  = 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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T1 - Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke

T2 - a systematic review and meta-analysis

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Zand, Ramin

AU - Sharma, Vijay K.

AU - Köhrmann, Martin

AU - Giannopoulos, Sotirios

AU - Dardiotis, Efthymios

AU - Alexandrov, Anne

AU - Mitsias, Panayiotis D.

AU - Schellinger, Peter D.

AU - Alexandrov, Andrei

PY - 2017/6/1

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N2 - 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 (OR adjusted ) 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 (OR adjusted  = 1.67, 95% CI 0.75–3.72), 3-month FI (OR adjusted  = 0.88, 95% CI 0.54–1.42), or death (OR adjusted  = 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.

AB - 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 (OR adjusted ) 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 (OR adjusted  = 1.67, 95% CI 0.75–3.72), 3-month FI (OR adjusted  = 0.88, 95% CI 0.54–1.42), or death (OR adjusted  = 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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