Abstract
MethodsWe analyzed prospectively collected data from the SITS International Stroke Thrombolysis Register (SITS‐ISTR) on consecutive IVT‐treated AIS patients during a seven‐year period (2010‐2017). In propensity‐score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment we compared: 1) SICH, according to SITS‐MOST, ECASS II and NINDS definitions, 2) 3‐month mortality, 3) 3‐month favorable functional outcome (FFO; mRS‐scores:0‐1), 4) 3‐month functional independence (FI; mRS‐scores:0‐2) and 5) distribution of the 3‐month mRS‐scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole or any other antiplatelet.
ResultsPropensity‐score matching resulted in two groups of 1043 patients each, balanced for all baseline characteristics. In the propensity‐score matched analysis the two groups had comparable (p>0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS‐MOST (2.9% vs. 1.5%; 95%CI:‐0.03,‐0.01), ECASS II (5.2% vs. 4.4%; 95%CI:‐0.03,0.01) and NINDS (7.7% vs. 6.6%; 95%CI:‐0.03,0.01) definitions. No differences in the 3‐month mortality (17.9% vs. 16.6%; 95%CI:‐0.05,0.02), FFO (45.6% vs. 46.0%; 95%CI:‐0.04,0.05), FI rates (59.2% vs. 60.7%; 95%CI:‐0.03,0.06) or the distribution in 3‐month mRS‐scores [2 (1‐4) vs. 2 (0‐4); 95%CI:‐0.29,0.09] were documented between the two groups.
Interpretation
Given that patients on dual antiplatelet pretreatment have similar SICH, 3‐month mortality rates and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients.
| Original language | English |
|---|---|
| Pages (from-to) | 89-97 |
| Number of pages | 9 |
| Journal | Annals of Neurology |
| Volume | 84 |
| Issue number | 1 |
| Early online date | 30 Jul 2018 |
| DOIs | |
| Publication status | Published - Jul 2018 |
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Keywords
- acute ischemic stroke
- dual antiplatelet therapy
- mortality
- functional outcome
- intracranial hemorrhage
Cite this
Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. / Tsivgoulis, Georgios (Corresponding Author); Katsanos, Aristeidis H.; Mavridis, Dimitris; Gdovinova, Zuzana; Karlinski, Michal; Macleod, Mary Joan; Strbian, Daniel; Ahmed , Niaz .
In: Annals of Neurology, Vol. 84, No. 1, 07.2018, p. 89-97.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets
AU - Tsivgoulis, Georgios
AU - Katsanos, Aristeidis H.
AU - Mavridis, Dimitris
AU - Gdovinova, Zuzana
AU - Karlinski, Michal
AU - Macleod, Mary Joan
AU - Strbian, Daniel
AU - Ahmed , Niaz
N1 - We thank all SITS-ISTR investigators and their centers for their participation. We also pass on our thanks to all patients who participated in SITS-ISTR. The current SITS registry is developed, maintained and upgraded by Zitelab, Copenhagen, Denmark, in close collaboration with SITS. SITS (Safe Implementation of Treatment in Stroke) is financed directly and indirectly by grants from Karolinska Institute, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institute, and private donors, as well as from an unrestricted sponsorship from Boehringer-Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority and Ferrer International. SITS is currently conducting studies supported by Boehringer-Ingelheim and EVER Pharma, as well as in collaboration with Karolinska Institute, supported by Stryker, Covidien and Phenox. N Ahmed is supported by grants provided by the Stockholm County Council and the Swedish Heart-Lung Foundation. No funding sources had part in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
PY - 2018/7
Y1 - 2018/7
N2 - ObjectiveWe assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset.MethodsWe analyzed prospectively collected data from the SITS International Stroke Thrombolysis Register (SITS‐ISTR) on consecutive IVT‐treated AIS patients during a seven‐year period (2010‐2017). In propensity‐score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment we compared: 1) SICH, according to SITS‐MOST, ECASS II and NINDS definitions, 2) 3‐month mortality, 3) 3‐month favorable functional outcome (FFO; mRS‐scores:0‐1), 4) 3‐month functional independence (FI; mRS‐scores:0‐2) and 5) distribution of the 3‐month mRS‐scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole or any other antiplatelet.ResultsPropensity‐score matching resulted in two groups of 1043 patients each, balanced for all baseline characteristics. In the propensity‐score matched analysis the two groups had comparable (p>0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS‐MOST (2.9% vs. 1.5%; 95%CI:‐0.03,‐0.01), ECASS II (5.2% vs. 4.4%; 95%CI:‐0.03,0.01) and NINDS (7.7% vs. 6.6%; 95%CI:‐0.03,0.01) definitions. No differences in the 3‐month mortality (17.9% vs. 16.6%; 95%CI:‐0.05,0.02), FFO (45.6% vs. 46.0%; 95%CI:‐0.04,0.05), FI rates (59.2% vs. 60.7%; 95%CI:‐0.03,0.06) or the distribution in 3‐month mRS‐scores [2 (1‐4) vs. 2 (0‐4); 95%CI:‐0.29,0.09] were documented between the two groups.InterpretationGiven that patients on dual antiplatelet pretreatment have similar SICH, 3‐month mortality rates and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients.
AB - ObjectiveWe assessed the outcomes of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients on dual antiplatelet therapy prior to stroke onset.MethodsWe analyzed prospectively collected data from the SITS International Stroke Thrombolysis Register (SITS‐ISTR) on consecutive IVT‐treated AIS patients during a seven‐year period (2010‐2017). In propensity‐score matched groups of patients with dual antiplatelet pretreatment and no antiplatelet pretreatment we compared: 1) SICH, according to SITS‐MOST, ECASS II and NINDS definitions, 2) 3‐month mortality, 3) 3‐month favorable functional outcome (FFO; mRS‐scores:0‐1), 4) 3‐month functional independence (FI; mRS‐scores:0‐2) and 5) distribution of the 3‐month mRS‐scores. Dual antiplatelet pretreatment was defined as all possible combinations among aspirin, clopidogrel, dipyridamole or any other antiplatelet.ResultsPropensity‐score matching resulted in two groups of 1043 patients each, balanced for all baseline characteristics. In the propensity‐score matched analysis the two groups had comparable (p>0.017 using Bonferroni correction for multiple comparisons) SICH rates according to SITS‐MOST (2.9% vs. 1.5%; 95%CI:‐0.03,‐0.01), ECASS II (5.2% vs. 4.4%; 95%CI:‐0.03,0.01) and NINDS (7.7% vs. 6.6%; 95%CI:‐0.03,0.01) definitions. No differences in the 3‐month mortality (17.9% vs. 16.6%; 95%CI:‐0.05,0.02), FFO (45.6% vs. 46.0%; 95%CI:‐0.04,0.05), FI rates (59.2% vs. 60.7%; 95%CI:‐0.03,0.06) or the distribution in 3‐month mRS‐scores [2 (1‐4) vs. 2 (0‐4); 95%CI:‐0.29,0.09] were documented between the two groups.InterpretationGiven that patients on dual antiplatelet pretreatment have similar SICH, 3‐month mortality rates and functional outcomes compared to patients with no antiplatelet pretreatment, dual antiplatelet pretreatment history should not be used as a reason to withhold IVT in otherwise eligible AIS patients.
KW - acute ischemic stroke
KW - dual antiplatelet therapy
KW - mortality
KW - functional outcome
KW - intracranial hemorrhage
U2 - 10.1002/ana.25269
DO - 10.1002/ana.25269
M3 - Article
VL - 84
SP - 89
EP - 97
JO - Annals of Neurology
JF - Annals of Neurology
SN - 0364-5134
IS - 1
ER -