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DOES PRE-TREATMENT WITH ANTIPLATELETS AFFECT THE OUTCOMES OF INTRAVENOUS THROMBOLYSIS?

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ESOC-2019

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Abstract

Introduction Prestroke antiplatelet therapy, particularly dual (any two agents) therapy, increases intracerebral haemorrhage (ICH) risk after thrombolysis. We investigated outcomes in patients thrombolysed with alteplase or tenecteplase on prior antiplatelet therapy. Methods We undertook pooled data of three trials comparing tenecteplase with alteplase, using binary logistic regression to compare the effects of prior antiplatelet use (none, single, or dual).on favourable (mRS 0-2) or poor (mRS 5-6) day 90 modified Rankin Scale (mRS), 24h NIHSS improvement (≥8 or= 0-1), ICH and symptomatic ICH (SICH) incidence. Results Of 291 patients, 135 were on no antiplatelet, 117 on single, and 19 on dual therapy; 4 were on warfarin. More patients on dual therapy had SICH and mRS 5-6. Adjusting for onset-to-treatment time, age and baseline NIHSS, odds of mRS 5-6 were non-significantly higher with single (OR 1.25, 95% CI 0.45-3.47) and dual (OR 1.98, [0.31-12.6]) therapy compared with none, as were odds of SICH (single: OR 3.99 [0.43-36.8]; dual: OR 4.21 [0.20-88.8]). There was no interaction between antiplatelet therapy and thrombolytic agent for any outcome. Conclusion Small numbers on prior dual antiplatelet therapy limit interpretation, but non-significantly higher odds and incidence of both SICH and mRS 5-6 with dual antiplatelet agents support the need for further investigation.

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