Abstract
Objectives
Alteplase, a tissue-type plasminogen activator, is recommended for ischemic stroke
patients presenting within 4.5 h. Due to bleeding risks, current guidelines advise
delaying antiplatelet therapy for 24 h after alteplase. However, specific scenarios
may require antiplatelet therapy to be given within the 24 h window. This study aimed
to examine the safety of early antiplatelet therapy administration within the first
24 h after alteplase.
Materials and methods
This study is a retrospective, observational study of adult patients with acute ischemic
stroke who received alteplase across a multi-hospital system. Patients were grouped
based on early antiplatelet therapy (within 24 h window) or as recommended per guidelines.
The occurrence of bleeding events, including symptomatic intracranial hemorrhage and/or
gastrointestinal bleeding, in-hospital mortality, unfavorable outcomes (modified Rankin
score 3–6), and hospital length of stay, were compared between groups.
Results
Patients were predominantly African American (72%) and female (53%) with a median
age of 62 years. Median baseline NIHSS scores were higher in the early group (5 vs.
7; p = 0.04), and patients in the early group were more likely to undergo endovascular
therapy (26% vs. 8%, p < 0.0001). In patients treated with alteplase only and who did not undergo endovascular
therapy, there was no difference in symptomatic intracranial hemorrhage (1.4% vs.
0%, p = 0.1), gastrointestinal bleeding, in-hospital mortality, unfavorable outcomes, or
length of stay.
Conclusions
In our retrospective analysis, early administration of antiplatelet therapy (< 24 h
post-alteplase) did not increase the risk of symptomatic intracranial hemorrhage,
gastrointestinal bleeding, or unfavorable outcomes in patients who received alteplase
alone for management of acute ischemic stroke. Prospective studies are needed to validate
these findings.
Keywords
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Article info
Publication history
Published online: November 05, 2022
Accepted:
October 27,
2022
Received in revised form:
October 26,
2022
Received:
September 27,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106868
Copyright
© 2022 Elsevier Inc. All rights reserved.
