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J Stroke. 2016 Sep;18(3):344-351. English. Original Article. https://doi.org/10.5853/jos.2016.00185
Choi JC , Lee JS , Park TH , Cho YJ , Park JM , Kang K , Lee KB , Lee SJ , Kim JG , Lee J , Park MS , Choi KH , Kim JT , Yu KH , Lee BC , Oh MS , Cha JK , Kim DH , Nah HW , Kim DE , Ryu WS , Kim BJ , Bae HJ , Kim WJ , Shin DI , Yeo MJ , Sohn SI , Hong JH , Lee J , Hong KS .
Department of Neurology, Jeju National University, Jeju, Korea.
Clinical Research Center, Asan Medical Center, Seoul, Korea.
Department of Neurology, Seoul Medical Center, Seoul, Korea.
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea. nrhks@paik.ac.kr
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Neurology, Eulji University Hospital, Daejeon, Korea.
Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
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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