J Clin Neurol.  2015 Oct;11(4):305-310. 10.3988/jcn.2015.11.4.305.

Postthrombolytic Antiplatelet Use for Patients with Intercerebral Hemorrhage without Extensive Parenchymal Involvement Does Not Worsen Outcome

• Jia W
• Zhou L
• Liao X
• Pan Y
• Wang Y

• KMID: 2179749
• DOI: http://doi.org/10.3988/jcn.2015.11.4.305

Abstract

BACKGROUND AND PURPOSE
It is unclear whether postthrombolytic antiplatelet (AP) therapy after thrombolytic-related hemorrhage without extensive parenchymal involvement (THEPI) affects the clinical outcome. This study explored whether AP administration in patients with THEPI affects short- and long-term outcomes.
METHODS
All of the data for this study were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. Patients with THEPI were assigned to either the AP (AP therapy should be commenced 24 h after intravenous thrombolysis) or AP-naive groups. THEPI was defined according to European-Australasian Acute Stroke Study II criteria. The 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, and 7-day and 90-day mortalities were compared between the AP and AP-naive groups. Logistic regression analysis was used to evaluate the effects of AP therapy on the short- and long-term clinical outcomes.
RESULTS
Of the 928 patients enrolled from those in the TIMS-China registry (n=1,440), 89 (9.6%) had nonsymptomatic intracerebral hemorrhage (ICH) within 24-36 h after thrombolysis; 33 (37%) of these patients were given AP therapy (AP group) and 56 (63%) were not (AP-naive group). No significant differences were found for the risk of 7-day aggravated ICH (p=0.998), 7-day NIHSS score (p=0.5491), 7-day mortality [odds ratio (OR)=3.427; 95% confidence interval (95% CI)=0.344-34.160; p=0.294], 90-day mortality (OR=0.788, 95% CI=0.154-4.040, p=0.775), or modified Rankin score 5 or 6 at 90-days (OR=1.108, 95% CI=0.249-4.928, p=0.893) between the AP and AP-naive groups after THEPI.
CONCLUSIONS
Early administration of postthrombolytic AP therapy after THEPI does not worsen either the short- or long-term outcome. AP therapy may be a reasonable treatment option for patients with THEPI to reduce the risk of ischemic stroke recurrence.

Keyword

ischemic stroke; thrombolytic-related hemorrhage; antiplatelet therapy; outcome

MeSH Terms

Cerebral Hemorrhage
China
Hemorrhage*
Humans
Logistic Models
Mortality
National Institutes of Health (U.S.)
Recurrence
Stroke

Figure

• 

  Fig. 1 Numbers of eligible study patients in the TIMS-China registry. AP: antiplatelet, ICH: intracerebral hemorrhage, NIHSS: National Institutes of Health Stroke Scale, rt-PA: recombinant tissue plasminogen activator, sICH: symptomatic ICH, TIMS-China: Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China.

• 

  Fig. 2 Comparison of function in different types of THEPI in the AP group at the 7- and 90-day follow-ups in patients from TIMS-China. AP: antiplatelet, ICH: intracerebral hemorrhage, mRS: modified Rankin Scale, THEPI: thrombolytic-related hemorrhage without extensive parenchymal involvement, TIMS-China: Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China.

• 

  Fig. 3 Comparison of function in different types of THEPI in the AP-naïve group at the 7- and 90-day follow-ups in patients from TIMS-China. AP: antiplatelet, ICH: intracerebral hemorrhage, mRS: modified Rankin Scale, THEPI: thrombolytic-related hemorrhage without extensive parenchymal involvement, TIMS-China: Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China.

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