Analysis of safety and efficacy of intravenous thrombolysis in patients on antithrombotic treatment

Abstract

Background: Previous treatment with antiplatelets or anticoagulants might modify outcome after thrombolysis either increasing the risk of haemorrhage or favouring the probability of good recovery. We analyze the effects of previous antithrombotic treatment in acute stroke patients treated with intravenous alteplase. Method(s): Multicenter observational prospective registry including consecutive acute stroke patients in stroke units from 5 university hospitals. Baseline characteristics, aetiology, risk factors, previous treatment with antiplatelets or anticoagulants, stroke severity (NIHSS) and time-to-treatment were recorded. Stroke outcome (NIHSS at 7 days and mRS at 3 months) as well as hemorrhagic complications, oedema and mortality were compared between patients with and without previous antithrombotic treatment. Result(s): 877 patients were studied, 265 (30.5%) were on antiplatelet treatment (220 ASA, 61 clopidogrel, 2 dypiridamol) and 32 (3.4%) on anticoagulants (19 acenocumarol [INR <1.7] 13 heparin [normal aPTT]. Patients on any antithrombotic treatment were older (72.29+/-10.6 vs 64.01+/-14.6, p<0.0001). There were no other differences in baseline characteristics. Hypertension, diabetes, dyslipidemia, prior stroke and atrial fibrillation were more prevalent among patients on antiplatelets, while diabetes, atrial fibrillation and prior stroke were among anticoagulated patients. We found no differences in neurological (NIHSS) nor functional (mRS) outcome between study groups. Symptomatic intracranial hemorrhage rate and mortality were similar in all study groups. Patients on anticoagulants developed less frequently cerebral oedema (17.2% vs 34,5%, p=0.043). Conclusion(s): Intravenous thrombolysis is not frequently performed on anticoagulated patients. However thrombolytic treatment seems to be safe in patients on previous antiplatelet and anticoagulant treatment.