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KMID : 1142120160180030344
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Journal of Stroke
2016 Volume.18 No. 3 p.344 ~ p.351
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Prestroke Antiplatelet Effect on Symptomatic Intracranial Hemorrhage and Functional Outcome in Intravenous Thrombolysis
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Choi Jay-Chol
Lee Ji-Sung
Park Tai-Hwan
Cho Yong-Jin
Park Jong-Moo
Kang Kyu-Sik
Lee Kyung-Bok
Lee Soo-Joo
Kim Jae-Guk
Lee Jun
Park Man-Seok
Choi Kang-Ho
Kim Joon-Tae
Yu Kyung-Ho
Lee Byung-Chul
Oh Mi-Sun
Cha Jae-Kwan
Kim Dae-Hyun
Nah Hyun-Wook
Kim Dong-Eog
Ryu Wi-Sun
Kim Beom-Joon
Bae Hee-Joon
Kim Wook-Joo
Shin Dong-Ick
Yeo Min-Ju
Sohn Sung-Il
Hong Jeong-Ho
Lee June-Young
Hong Keun-Sik
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Abstract
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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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KEYWORD
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Stroke, Thrombolytic therapy, Platelet aggregation inhibitors, Outcome assessment
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