Abstract TMP22: Safety of Pretreatment With Dual Antiplatelet Therapy in Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Ali Kerro ◽  
Aristeidis H Katsanos ◽  
Rashi Krishnan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Intravenous Thrombolysis

scholarly journals Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Luigi Cirillo ◽  
Daniele Giuseppe Romano ◽  
Gianfranco Vornetti ◽  
Giulia Frauenfelder ◽  
Chiara Tamburrano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Internal Carotid ◽  
Dual Antiplatelet Therapy ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Response To Treatment

Abstract Background Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies ​​have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to isolated ICA occlusion or TL. Methods We assessed the association between 90-day outcome and clinical, demographic, imaging, and procedure data in 51 consecutive patients with acute isolated ICA occlusion or TL who underwent EVT. We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, postprocedural therapy and complications. Results A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67 %) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8 %. Conclusions Our study has shown that EVT in the treatment of AIS due to ICA occlusion is safe, and effective in determining a good functional outcome. ICA stenting led to good angiographic results and therapy with a glycoprotein IIb / IIIa inhibitor immediately after stent release did not result in a greater risk of hemorrhage. The use of post-procedural dual antiplatelet therapy was associated with favorable outcome, without a significant increase in hemorrhagic transformation.

scholarly journals Safety of Antiplatelet Therapy Prior to Intravenous Thrombolysis in Acute Ischemic Stroke

2008 ◽  
Vol 65 (5) ◽  
Author(s):  
Maarten Uyttenboogaart ◽  
Marcus W. Koch ◽  
Karen Koopman ◽  
Patrick C. A. J. Vroomen ◽  
Jacques De Keyser ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Intravenous Thrombolysis

Indications and Evidence for Dual Antiplatelet Therapy After Acute Ischemic Stroke

2020 ◽  
Vol 43 (2) ◽  
pp. 122-137
Author(s):  
Jessica Ringler ◽  
Mackenzie Steck ◽  
Samarth P. Shah ◽  
Katleen W. Chester
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy

Dual Antiplatelet Therapy after Intravenous Thrombolysis for Acute Minor Ischemic Stroke

2019 ◽  
Vol 82 (4-6) ◽  
pp. 93-98 ◽  
Author(s):  
Guangjian Zhao ◽  
Fanzhen Lin ◽  
Ziran Wang ◽  
Xiaolin Shao ◽  
Yanxue Gong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Recurrence ◽  
Minor Ischemic Stroke ◽  
Significant Difference ◽  
Scale Scores ◽  
Symptomatic Intracranial Hemorrhage

Objective: To verify the efficacy and safety of dual antiplatelet therapy after intravenous thrombolysis for acute minor ischemic stroke (AMIS). Methods: AMIS patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from January to October 2018 were retrospectively analyzed and divided into the aspirin (ASP) and ASP + clopidogrel (ASP-CLO) groups based on the type of antiplatelet therapy to compare the rates of good clinical outcome, symptomatic intracranial hemorrhage (SICH) after thrombolysis, and mortality in 90 days. Results: A total of 207 patients were included (group ASP, 105 patients; group ASP-CLO, 102 patients). There was no significant difference in the baseline clinical data between the 2 groups. The ­90-day modified Rankin scale scores (66.7 vs. 82.4%, p = 0.009) showed a statistically significant difference, but SICH (1.0 vs. 1.0%, p = 0.917) and 90-day mortality (1.9 vs. 1.0%, p = 0.585) showed no significant difference between the 2 groups. Conclusions: Short-term (21 days) dual antiplatelet therapy after rt-PA intravenous thrombolysis for AMIS can improve the prognosis, reduce the risk of stroke recurrence, without increasing the risk of bleeding and mortality.

scholarly journals Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Receiving Antiplatelet Therapy at Stroke Onset

Stroke ◽  
2010 ◽  
Vol 41 (2) ◽  
pp. 288-294 ◽  
Author(s):  
Jennifer Diedler ◽  
Niaz Ahmed ◽  
Marek Sykora ◽  
Maarten Uyttenboogaart ◽  
Karsten Overgaard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Intravenous Thrombolysis ◽  
Stroke Onset

scholarly journals Impact of Diabetes on Platelet Function in Acute Ischemic Stroke Patients Taking Dual Antiplatelet Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Yinping Guo ◽  
Yi Zhang ◽  
Jing Zhao ◽  
Lingshan Wu ◽  
Zhiyuan Yu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Significant Risk ◽  
Maximum Amplitude ◽  
Stroke Patients ◽  
Clot Strength

Objectives: Diabetes mellitus (DM) is a significant risk factor for ischemic stroke and associated with platelet reactivity. We aim to evaluate the effect of DM on platelet function in acute ischemic stroke patients taking dual antiplatelet therapy (DAPT).Methods: We consecutively included patients with acute ischemic stroke taking DAPT. Platelet function was assessed by thromboelastography and the arachidonic acid (AA) or adenosine diphosphate (ADP) induced platelet inhibition rate were used to confirmed the high-residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel. We classified patients into DM and non-DM groups. The association between DM and platelet function was assessed and the confounding factors were adjusted by propensity score matching (PSM) analysis. The independent risk factors of HRPR were determined by multivariate logistic regression analysis.Results: A total of 1,071 acute ischemic stroke patients, 712 in the non-DM group and 359 in the DM group, were included. Patients with DM had a significantly higher maximum amplitude (63.0 vs. 62.0 mm, P &lt; 0.01), ADP-induced clot strength (34.6 vs. 30.3 mm, P &lt; 0.01) and clopidogrel HRPR rate (22.6% vs. 17.3%, P = 0.038) than those without DM. Among 662 patients after PSM, the maximum amplitude (63.1 vs. 62.5 mm, P = 0.032), ADP-induced clot strength (34.6 vs. 29.3 mm, P &lt; 0.01) and clopidogrel HRPR rate (23.0% vs. 15.7%, P = 0.018) is still higher in the DM group. DM was an independent factor of clopidogrel HRPR (OR = 1.48, 95% CI: 1.03–2.07, P &lt; 0.05).Conclusions: In acute ischemic stroke patients taking DAPT, DM is associated with increased platelet reactivity and higher prevalence of clopidogrel HRPR.

scholarly journals Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke

2021 ◽  
pp. neurintsurg-2021-017615
Author(s):  
Dan He ◽  
Yinping Guo ◽  
Yi Zhang ◽  
Jing Zhao ◽  
Lingshan Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Area Under The Curve ◽  
Maximum Amplitude ◽  
Adenosine Diphosphate ◽  
Fibrin Clot ◽  
Hemorrhagic Events ◽  
Scale Scores

BackgroundStratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events.ObjectiveThe present study aims to discover predictors for hemorrhage events after DAPT based on parameters such as TEG.MethodsA total of 859 patients with acute ischemic stroke who received DAPT were recruited consecutively. Demographic, clinical, and neuroimaging characteristics were evaluated at baseline; TEG parameters were obtained 7 days later after DAPT. Hemorrhagic events were monitored about 1 month after the stroke.ResultsOf the patients, 61 (7.1%) had hemorrhagic events. Patients in the hemorrhage group had a lower adenosine diphosphate (ADP)-induced platelet-fibrin clot maximum amplitude and a higher ADP inhibition rate (ADP%) than those in the non-hemorrhage group (p<0.05). ADP% was confirmed as an independent predictor of hemorrhagic events with an optimal cut-off point of 83.3% (area under the curve (AUC) = 0.665, 95% CI 0.573 to 0.767, p<0.01). We constructed a logistic model based on D-dimer, National Institutes of Health Stroke Scale scores, and ADP% to predict hemorrhagic events in patients with acute ischemic stroke during DAPT (AUC=0.720, 95% CI 0.625 to 0.858, p<0.01), with a sensitivity of 72.1% and a specificity of 76.5%.ConclusionsMonitoring changes of TEG parameters helps to guide personalized DAPT for patients with ischemic stroke. A 30–82.3% range of ADP% is recommended for DAPT treatment.

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