Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets

Georgios Tsivgoulis, Aristeidis H. Katsanos, Dimitris Mavridis, Zuzana Gdovinova, Michał Karliński, Mary Joan Macleod, Daniel Strbian, Niaz Ahmed

Research output: Contribution to journalArticle

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Abstract

Objective: We assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset. Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register on consecutive IVT-treated AIS patients during a 7-year period (2010–2017). In propensity score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment, we compared: (1) symptomatic intracerebral hemorrhage (SICH), according to SITS Monitoring Study (MOST), European Cooperative Acute Stroke Study (ECASS) II, and National Institute of Neurological Disorders and Stroke (NINDS) definitions; (2) 3-month mortality; (3) 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores = 0–1); (4) 3-month functional independence (FI; mRS scores = 0–2); and (5) distribution of the 3-month mRS scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole, and any other antiplatelet. Results: Propensity score matching resulted in 2 groups of 1,043 patients each, balanced for all baseline characteristics. In the propensity score matched analysis, the 2 groups had comparable (p > 0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS-MOST (2.9% vs 1.5%, 95% confidence interval [CI] = −0.03 to −0.01), ECASS II (5.2% vs 4.4%, 95% CI = −0.03 to 0.01), and NINDS (7.7% vs 6.6%, 95% CI = −0.03 to 0.01) definitions. No differences in the 3-month mortality (17.9% vs 16.6%, 95% CI = −0.05 to 0.02), FFO (45.6% vs 46.0%, 95% CI = −0.04 to 0.05), FI (59.2% vs 60.7%, 95% CI = −0.03 to 0.06), or distribution in 3-month mRS scores (2 [1–4] vs 2 [0–4], 95% CI = −0.29 to 0.09) were documented between the 2 groups. Interpretation: Given that patients on dual antiplatelet pretreatment have similar SICH, 3-month mortality rates, and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients. Ann Neurol 2018;83:89–97.

Original languageEnglish (US)
Pages (from-to)89-97
Number of pages9
JournalAnnals of Neurology
Volume84
Issue number1
DOIs
StatePublished - Jul 1 2018

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Stroke
Confidence Intervals
Propensity Score
Cerebral Hemorrhage
National Institute of Neurological Disorders and Stroke
clopidogrel
Mortality
Dipyridamole
Therapeutics
Aspirin
Research Design
History

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Tsivgoulis, G., Katsanos, A. H., Mavridis, D., Gdovinova, Z., Karliński, M., Macleod, M. J., ... Ahmed, N. (2018). Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. Annals of Neurology, 84(1), 89-97. https://doi.org/10.1002/ana.25269

Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Mavridis, Dimitris; Gdovinova, Zuzana; Karliński, Michał; Macleod, Mary Joan; Strbian, Daniel; Ahmed, Niaz.

In: Annals of Neurology, Vol. 84, No. 1, 01.07.2018, p. 89-97.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Mavridis, D, Gdovinova, Z, Karliński, M, Macleod, MJ, Strbian, D & Ahmed, N 2018, 'Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets', Annals of Neurology, vol. 84, no. 1, pp. 89-97. https://doi.org/10.1002/ana.25269
Tsivgoulis G, Katsanos AH, Mavridis D, Gdovinova Z, Karliński M, Macleod MJ et al. Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. Annals of Neurology. 2018 Jul 1;84(1):89-97. https://doi.org/10.1002/ana.25269
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Mavridis, Dimitris ; Gdovinova, Zuzana ; Karliński, Michał ; Macleod, Mary Joan ; Strbian, Daniel ; Ahmed, Niaz. / Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. In: Annals of Neurology. 2018 ; Vol. 84, No. 1. pp. 89-97.
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abstract = "Objective: We assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset. Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register on consecutive IVT-treated AIS patients during a 7-year period (2010–2017). In propensity score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment, we compared: (1) symptomatic intracerebral hemorrhage (SICH), according to SITS Monitoring Study (MOST), European Cooperative Acute Stroke Study (ECASS) II, and National Institute of Neurological Disorders and Stroke (NINDS) definitions; (2) 3-month mortality; (3) 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores = 0–1); (4) 3-month functional independence (FI; mRS scores = 0–2); and (5) distribution of the 3-month mRS scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole, and any other antiplatelet. Results: Propensity score matching resulted in 2 groups of 1,043 patients each, balanced for all baseline characteristics. In the propensity score matched analysis, the 2 groups had comparable (p > 0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS-MOST (2.9{\%} vs 1.5{\%}, 95{\%} confidence interval [CI] = −0.03 to −0.01), ECASS II (5.2{\%} vs 4.4{\%}, 95{\%} CI = −0.03 to 0.01), and NINDS (7.7{\%} vs 6.6{\%}, 95{\%} CI = −0.03 to 0.01) definitions. No differences in the 3-month mortality (17.9{\%} vs 16.6{\%}, 95{\%} CI = −0.05 to 0.02), FFO (45.6{\%} vs 46.0{\%}, 95{\%} CI = −0.04 to 0.05), FI (59.2{\%} vs 60.7{\%}, 95{\%} CI = −0.03 to 0.06), or distribution in 3-month mRS scores (2 [1–4] vs 2 [0–4], 95{\%} CI = −0.29 to 0.09) were documented between the 2 groups. Interpretation: Given that patients on dual antiplatelet pretreatment have similar SICH, 3-month mortality rates, and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients. Ann Neurol 2018;83:89–97.",
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AU - Gdovinova, Zuzana

AU - Karliński, Michał

AU - Macleod, Mary Joan

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N2 - Objective: We assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset. Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register on consecutive IVT-treated AIS patients during a 7-year period (2010–2017). In propensity score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment, we compared: (1) symptomatic intracerebral hemorrhage (SICH), according to SITS Monitoring Study (MOST), European Cooperative Acute Stroke Study (ECASS) II, and National Institute of Neurological Disorders and Stroke (NINDS) definitions; (2) 3-month mortality; (3) 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores = 0–1); (4) 3-month functional independence (FI; mRS scores = 0–2); and (5) distribution of the 3-month mRS scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole, and any other antiplatelet. Results: Propensity score matching resulted in 2 groups of 1,043 patients each, balanced for all baseline characteristics. In the propensity score matched analysis, the 2 groups had comparable (p > 0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS-MOST (2.9% vs 1.5%, 95% confidence interval [CI] = −0.03 to −0.01), ECASS II (5.2% vs 4.4%, 95% CI = −0.03 to 0.01), and NINDS (7.7% vs 6.6%, 95% CI = −0.03 to 0.01) definitions. No differences in the 3-month mortality (17.9% vs 16.6%, 95% CI = −0.05 to 0.02), FFO (45.6% vs 46.0%, 95% CI = −0.04 to 0.05), FI (59.2% vs 60.7%, 95% CI = −0.03 to 0.06), or distribution in 3-month mRS scores (2 [1–4] vs 2 [0–4], 95% CI = −0.29 to 0.09) were documented between the 2 groups. Interpretation: Given that patients on dual antiplatelet pretreatment have similar SICH, 3-month mortality rates, and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients. Ann Neurol 2018;83:89–97.

AB - Objective: We assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset. Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register on consecutive IVT-treated AIS patients during a 7-year period (2010–2017). In propensity score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment, we compared: (1) symptomatic intracerebral hemorrhage (SICH), according to SITS Monitoring Study (MOST), European Cooperative Acute Stroke Study (ECASS) II, and National Institute of Neurological Disorders and Stroke (NINDS) definitions; (2) 3-month mortality; (3) 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] scores = 0–1); (4) 3-month functional independence (FI; mRS scores = 0–2); and (5) distribution of the 3-month mRS scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole, and any other antiplatelet. Results: Propensity score matching resulted in 2 groups of 1,043 patients each, balanced for all baseline characteristics. In the propensity score matched analysis, the 2 groups had comparable (p > 0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS-MOST (2.9% vs 1.5%, 95% confidence interval [CI] = −0.03 to −0.01), ECASS II (5.2% vs 4.4%, 95% CI = −0.03 to 0.01), and NINDS (7.7% vs 6.6%, 95% CI = −0.03 to 0.01) definitions. No differences in the 3-month mortality (17.9% vs 16.6%, 95% CI = −0.05 to 0.02), FFO (45.6% vs 46.0%, 95% CI = −0.04 to 0.05), FI (59.2% vs 60.7%, 95% CI = −0.03 to 0.06), or distribution in 3-month mRS scores (2 [1–4] vs 2 [0–4], 95% CI = −0.29 to 0.09) were documented between the 2 groups. Interpretation: Given that patients on dual antiplatelet pretreatment have similar SICH, 3-month mortality rates, and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients. Ann Neurol 2018;83:89–97.

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