Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke

Georgios Tsivgoulis, Nitin Goyal, Ali Kerro, Aristeidis H. Katsanos, Rashi Krishnan, Konark Malhotra, Abhi Pandhi, Peter Duden, Aman Deep, Reza Bavarsad Shahripour, Tomas Bryndziar, Katherine Nearing, Boris Chulpayev, Jason Chang, Ramin Zand, Anne W. Alexandrov, Andrei Alexandrov

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: We sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study. METHODS: We compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality. RESULTS: Among 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes. CONCLUSIONS: DAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

Original languageEnglish (US)
Pages (from-to)e1067-e1076
JournalNeurology
Volume91
Issue number11
DOIs
StatePublished - Sep 11 2018

Fingerprint

Stroke
Intracranial Hemorrhages
Therapeutics
Propensity Score
Odds Ratio
Confidence Intervals
Safety
Mortality
Multicenter Studies
Prospective Studies
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke. / Tsivgoulis, Georgios; Goyal, Nitin; Kerro, Ali; Katsanos, Aristeidis H.; Krishnan, Rashi; Malhotra, Konark; Pandhi, Abhi; Duden, Peter; Deep, Aman; Shahripour, Reza Bavarsad; Bryndziar, Tomas; Nearing, Katherine; Chulpayev, Boris; Chang, Jason; Zand, Ramin; Alexandrov, Anne W.; Alexandrov, Andrei.

In: Neurology, Vol. 91, No. 11, 11.09.2018, p. e1067-e1076.

Research output: Contribution to journalArticle

Tsivgoulis, G, Goyal, N, Kerro, A, Katsanos, AH, Krishnan, R, Malhotra, K, Pandhi, A, Duden, P, Deep, A, Shahripour, RB, Bryndziar, T, Nearing, K, Chulpayev, B, Chang, J, Zand, R, Alexandrov, AW & Alexandrov, A 2018, 'Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke', Neurology, vol. 91, no. 11, pp. e1067-e1076. https://doi.org/10.1212/WNL.0000000000006168
Tsivgoulis, Georgios ; Goyal, Nitin ; Kerro, Ali ; Katsanos, Aristeidis H. ; Krishnan, Rashi ; Malhotra, Konark ; Pandhi, Abhi ; Duden, Peter ; Deep, Aman ; Shahripour, Reza Bavarsad ; Bryndziar, Tomas ; Nearing, Katherine ; Chulpayev, Boris ; Chang, Jason ; Zand, Ramin ; Alexandrov, Anne W. ; Alexandrov, Andrei. / Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke. In: Neurology. 2018 ; Vol. 91, No. 11. pp. e1067-e1076.
@article{3c2bd6ebe2a947b594e9550bdb69e44d,
title = "Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke",
abstract = "OBJECTIVE: We sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study. METHODS: We compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality. RESULTS: Among 790 IVT patients, 58 (7{\%}) were on DAPP before stroke (mean age 68 ± 13 years; 57{\%} men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4{\%} vs 3.2{\%}). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95{\%} confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95{\%} confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes. CONCLUSIONS: DAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.",
author = "Georgios Tsivgoulis and Nitin Goyal and Ali Kerro and Katsanos, {Aristeidis H.} and Rashi Krishnan and Konark Malhotra and Abhi Pandhi and Peter Duden and Aman Deep and Shahripour, {Reza Bavarsad} and Tomas Bryndziar and Katherine Nearing and Boris Chulpayev and Jason Chang and Ramin Zand and Alexandrov, {Anne W.} and Andrei Alexandrov",
year = "2018",
month = "9",
day = "11",
doi = "10.1212/WNL.0000000000006168",
language = "English (US)",
volume = "91",
pages = "e1067--e1076",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke

AU - Tsivgoulis, Georgios

AU - Goyal, Nitin

AU - Kerro, Ali

AU - Katsanos, Aristeidis H.

AU - Krishnan, Rashi

AU - Malhotra, Konark

AU - Pandhi, Abhi

AU - Duden, Peter

AU - Deep, Aman

AU - Shahripour, Reza Bavarsad

AU - Bryndziar, Tomas

AU - Nearing, Katherine

AU - Chulpayev, Boris

AU - Chang, Jason

AU - Zand, Ramin

AU - Alexandrov, Anne W.

AU - Alexandrov, Andrei

PY - 2018/9/11

Y1 - 2018/9/11

N2 - OBJECTIVE: We sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study. METHODS: We compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality. RESULTS: Among 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes. CONCLUSIONS: DAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

AB - OBJECTIVE: We sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study. METHODS: We compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality. RESULTS: Among 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes. CONCLUSIONS: DAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

UR - http://www.scopus.com/inward/record.url?scp=85064579290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064579290&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000006168

DO - 10.1212/WNL.0000000000006168

M3 - Article

VL - 91

SP - e1067-e1076

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 11

ER -