J Stroke.
2016 Sep;18(3):344-351. 10.5853/jos.2016.00185.
Prestroke Antiplatelet Effect on Symptomatic Intracranial Hemorrhage and Functional Outcome in Intravenous Thrombolysis
- Affiliations
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- 1Department of Neurology, Jeju National University, Jeju, Korea.
- 2Clinical Research Center, Asan Medical Center, Seoul, Korea.
- 3Department of Neurology, Seoul Medical Center, Seoul, Korea.
- 4Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea. nrhks@paik.ac.kr
- 5Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
- 6Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
- 7Department of Neurology, Eulji University Hospital, Daejeon, Korea.
- 8Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
- 9Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
- 10Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
- 11Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
- 12Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
- 13Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 14Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
- 15Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
- 16Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
- 17Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
- KMID: 2359512
- DOI: http://doi.org/10.5853/jos.2016.00185
Abstract
- BACKGROUND AND PURPOSE
About 30%-40% of stroke patients are taking antiplatelet at the time of their strokes, which might increase the risk of symptomatic intracranial hemorrhage (SICH) with intravenous tissue plasminogen activator (IV-TPA) therapy. We aimed to assess the effect of prestroke antiplatelet on the SICH risk and functional outcome in Koreans treated with IV-TPA.
METHODS
From a prospective stroke registry, we identified patients treated with IV-TPA between October 2009 and November 2014. Prestroke antiplatelet use was defined as taking antiplatelet within 7 days before the stroke onset. The primary outcome was SICH. Secondary outcomes were discharge modified Rankin Scale (mRS) score and in-hospital mortality.
RESULTS
Of 1,715 patients treated with IV-TPA, 441 (25.7%) were on prestroke antiplatelet. Prestroke antiplatelet users versus non-users were more likely to be older, to have multiple vascular risk factors. Prestroke antiplatelet use was associated with an increased risk of SICH (5.9% vs. 3.0%; adjusted odds ratio [OR] 1.79 [1.05-3.04]). However, at discharge, the two groups did not differ in mRS distribution (adjusted OR 0.90 [0.72-1.14]), mRS 0-1 outcome (34.2% vs. 33.7%; adjusted OR 1.27 [0.94-1.72), mRS 0-2 outcome (52.4% vs. 52.9%; adjusted OR 1.21 [0.90-1.63]), and in-hospital mortality (6.1% vs. 4.2%; adjusted OR 1.19 [0.71-2.01]).
CONCLUSIONS
Despite an increased risk of SICH, prestroke antiplatelet users compared to non-users had comparable functional outcomes and in-hospital mortality with IV-TPA therapy. Our results support the use of IV-TPA in eligible patients taking antiplatelet therapy before their stroke onset.
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