Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis
Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH. To determine the associated risk of sI...
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| Veröffentlicht in: | Archives of neurology (Chicago) 2024-07, Vol.81 (7), p.722 |
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| creator | Peng, Teng J Schwamm, Lee H Fonarow, Gregg C Hassan, Ameer E Hill, Michelle Messé, Steven R Coronado, Fatima Falcone, Guido J Sharma, Richa |
| description | Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH.
To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
This cohort study used data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry between 2013 and 2021. Data were obtained from hospitals in the GWTG-Stroke registry. This study included patients hospitalized with acute ischemic stroke and treated with IV-tPA. Data were analyzed from January 2013 to December 2021.
Prestroke DAPT before treatment with IV-tPA for acute ischemic stroke.
sICH, In-hospital death, discharge modified Rankin scale score, and other life-threatening systemic hemorrhages.
Of 409 673 participants, 321 819 patients (mean [SD] age, 68.6 [15.1] years; 164 587 female [51.1%]) who were hospitalized with acute ischemic stroke and treated with IV-tPA were included in the analysis. The rate of sICH was 2.9% (5200 of 182 344), 3.8% (4457 of 117 670), and 4.1% (893 of 21 805) among patients treated with no antiplatelet therapy, single antiplatelet therapy (SAPT), and DAPT, respectively (P |
| doi_str_mv | 10.1001/jamaneurol.2024.1312 |
| format | Article |
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To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
This cohort study used data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry between 2013 and 2021. Data were obtained from hospitals in the GWTG-Stroke registry. This study included patients hospitalized with acute ischemic stroke and treated with IV-tPA. Data were analyzed from January 2013 to December 2021.
Prestroke DAPT before treatment with IV-tPA for acute ischemic stroke.
sICH, In-hospital death, discharge modified Rankin scale score, and other life-threatening systemic hemorrhages.
Of 409 673 participants, 321 819 patients (mean [SD] age, 68.6 [15.1] years; 164 587 female [51.1%]) who were hospitalized with acute ischemic stroke and treated with IV-tPA were included in the analysis. The rate of sICH was 2.9% (5200 of 182 344), 3.8% (4457 of 117 670), and 4.1% (893 of 21 805) among patients treated with no antiplatelet therapy, single antiplatelet therapy (SAPT), and DAPT, respectively (P < .001). In adjusted analyses after propensity score subclassification, both SAPT (odds ratio [OR], 1.13; 95% CI, 1.07-1.19) and DAPT (OR, 1.28; 95% CI, 1.14-1.42) were associated with increased risks of sICH. Prestroke antiplatelet medications were associated with lower odds of discharge mRS score of 2 or less compared with no medication (SAPT OR, 0.92; 95% CI, 0.90-0.95; DAPT OR, 0.94; 95% CI, 0.88-0.98). Results of a subgroup analysis of patients taking DAPT exposed to aspirin-clopidogrel vs aspirin-ticagrelor combination therapy were not significant (OR, 1.35; 95% CI, 0.84-1.86).
Prestroke DAPT was associated with a significantly elevated risk of sICH among patients with ischemic stroke who were treated with thrombolysis; however, the absolute increase in risk was small. Patients exposed to antiplatelet medications did not have excess sICH compared with landmark trials, which demonstrated overall clinical benefit of thrombolysis therapy for acute ischemic stroke.</description><identifier>ISSN: 2168-6149</identifier><identifier>ISSN: 2168-6157</identifier><identifier>EISSN: 2168-6157</identifier><identifier>DOI: 10.1001/jamaneurol.2024.1312</identifier><identifier>PMID: 38767894</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aspirin ; Clinical trials ; Clopidogrel ; Data analysis ; Exposure ; Hemorrhage ; Hospitals ; Ischemia ; Patients ; Risk analysis ; Stroke ; Subgroups ; Therapy ; Thrombolysis</subject><ispartof>Archives of neurology (Chicago), 2024-07, Vol.81 (7), p.722</ispartof><rights>Copyright American Medical Association Jul 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c335t-d351918837c8139a9bb6f96640263cafb4e8f86df79d850003c210bafbeea2413</citedby><cites>FETCH-LOGICAL-c335t-d351918837c8139a9bb6f96640263cafb4e8f86df79d850003c210bafbeea2413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38767894$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peng, Teng J</creatorcontrib><creatorcontrib>Schwamm, Lee H</creatorcontrib><creatorcontrib>Fonarow, Gregg C</creatorcontrib><creatorcontrib>Hassan, Ameer E</creatorcontrib><creatorcontrib>Hill, Michelle</creatorcontrib><creatorcontrib>Messé, Steven R</creatorcontrib><creatorcontrib>Coronado, Fatima</creatorcontrib><creatorcontrib>Falcone, Guido J</creatorcontrib><creatorcontrib>Sharma, Richa</creatorcontrib><title>Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis</title><title>Archives of neurology (Chicago)</title><addtitle>JAMA Neurol</addtitle><description>Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH.
To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
This cohort study used data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry between 2013 and 2021. Data were obtained from hospitals in the GWTG-Stroke registry. This study included patients hospitalized with acute ischemic stroke and treated with IV-tPA. Data were analyzed from January 2013 to December 2021.
Prestroke DAPT before treatment with IV-tPA for acute ischemic stroke.
sICH, In-hospital death, discharge modified Rankin scale score, and other life-threatening systemic hemorrhages.
Of 409 673 participants, 321 819 patients (mean [SD] age, 68.6 [15.1] years; 164 587 female [51.1%]) who were hospitalized with acute ischemic stroke and treated with IV-tPA were included in the analysis. The rate of sICH was 2.9% (5200 of 182 344), 3.8% (4457 of 117 670), and 4.1% (893 of 21 805) among patients treated with no antiplatelet therapy, single antiplatelet therapy (SAPT), and DAPT, respectively (P < .001). In adjusted analyses after propensity score subclassification, both SAPT (odds ratio [OR], 1.13; 95% CI, 1.07-1.19) and DAPT (OR, 1.28; 95% CI, 1.14-1.42) were associated with increased risks of sICH. Prestroke antiplatelet medications were associated with lower odds of discharge mRS score of 2 or less compared with no medication (SAPT OR, 0.92; 95% CI, 0.90-0.95; DAPT OR, 0.94; 95% CI, 0.88-0.98). Results of a subgroup analysis of patients taking DAPT exposed to aspirin-clopidogrel vs aspirin-ticagrelor combination therapy were not significant (OR, 1.35; 95% CI, 0.84-1.86).
Prestroke DAPT was associated with a significantly elevated risk of sICH among patients with ischemic stroke who were treated with thrombolysis; however, the absolute increase in risk was small. Patients exposed to antiplatelet medications did not have excess sICH compared with landmark trials, which demonstrated overall clinical benefit of thrombolysis therapy for acute ischemic stroke.</description><subject>Aspirin</subject><subject>Clinical trials</subject><subject>Clopidogrel</subject><subject>Data analysis</subject><subject>Exposure</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Ischemia</subject><subject>Patients</subject><subject>Risk analysis</subject><subject>Stroke</subject><subject>Subgroups</subject><subject>Therapy</subject><subject>Thrombolysis</subject><issn>2168-6149</issn><issn>2168-6157</issn><issn>2168-6157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkUtLxDAQx4MoKuo3EAl48bJrXm2T47I-QVB8nEvaTrVr09RJethvbxZf4FxmYH4zzPz_hBxzNueM8fOVdXaACX0_F0yoOZdcbJF9wXM9y3lWbP_WyuyRoxBWLIVmTEm1S_akLvJCG7VP3NIPEdzo0eKaPiCEiP4d6MVke7oYYjf2NkIPkb4EoHZo6NPajdE7G7ua3g4RbQ0IFSb8BpxHfLOvQB-78E4XbQSkz2_oXeX7dejCIdlpbR_g6DsfkJery-flzezu_vp2ubib1VJmcdbIjBuutSxqzaWxpqry1uS5YiKXtW0rBbrVedMWptFZekzWgrMqNQCsUFwekLOvvSP6jyn9VLou1ND3STQ_hVKyrGCF5Nwk9PQfuvITDum6RBkpmBFCJEp9UTX6EBDacsTOJclKzsqNI-WfI-XGkXLjSBo7-V4-VQ6a36Ef_eUnycSKuQ</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Peng, Teng J</creator><creator>Schwamm, Lee H</creator><creator>Fonarow, Gregg C</creator><creator>Hassan, Ameer E</creator><creator>Hill, Michelle</creator><creator>Messé, Steven R</creator><creator>Coronado, Fatima</creator><creator>Falcone, Guido J</creator><creator>Sharma, Richa</creator><general>American Medical Association</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20240701</creationdate><title>Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis</title><author>Peng, Teng J ; Schwamm, Lee H ; Fonarow, Gregg C ; Hassan, Ameer E ; Hill, Michelle ; Messé, Steven R ; Coronado, Fatima ; Falcone, Guido J ; Sharma, Richa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c335t-d351918837c8139a9bb6f96640263cafb4e8f86df79d850003c210bafbeea2413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aspirin</topic><topic>Clinical trials</topic><topic>Clopidogrel</topic><topic>Data analysis</topic><topic>Exposure</topic><topic>Hemorrhage</topic><topic>Hospitals</topic><topic>Ischemia</topic><topic>Patients</topic><topic>Risk analysis</topic><topic>Stroke</topic><topic>Subgroups</topic><topic>Therapy</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peng, Teng J</creatorcontrib><creatorcontrib>Schwamm, Lee H</creatorcontrib><creatorcontrib>Fonarow, Gregg C</creatorcontrib><creatorcontrib>Hassan, Ameer E</creatorcontrib><creatorcontrib>Hill, Michelle</creatorcontrib><creatorcontrib>Messé, Steven R</creatorcontrib><creatorcontrib>Coronado, Fatima</creatorcontrib><creatorcontrib>Falcone, Guido J</creatorcontrib><creatorcontrib>Sharma, Richa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of neurology (Chicago)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peng, Teng J</au><au>Schwamm, Lee H</au><au>Fonarow, Gregg C</au><au>Hassan, Ameer E</au><au>Hill, Michelle</au><au>Messé, Steven R</au><au>Coronado, Fatima</au><au>Falcone, Guido J</au><au>Sharma, Richa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis</atitle><jtitle>Archives of neurology (Chicago)</jtitle><addtitle>JAMA Neurol</addtitle><date>2024-07-01</date><risdate>2024</risdate><volume>81</volume><issue>7</issue><spage>722</spage><pages>722-</pages><issn>2168-6149</issn><issn>2168-6157</issn><eissn>2168-6157</eissn><abstract>Intravenous alteplase (IV-tPA) can be administered to patients with acute ischemic stroke but is associated with symptomatic intracerebral hemorrhage (sICH). It is unclear if patients taking prestroke dual antiplatelet therapy (DAPT) are at higher risk of sICH.
To determine the associated risk of sICH in patients taking prestroke dual antiplatelet therapy receiving alteplase for acute ischemic stroke using propensity score matching analysis.
This cohort study used data from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke (GWTG-Stroke) registry between 2013 and 2021. Data were obtained from hospitals in the GWTG-Stroke registry. This study included patients hospitalized with acute ischemic stroke and treated with IV-tPA. Data were analyzed from January 2013 to December 2021.
Prestroke DAPT before treatment with IV-tPA for acute ischemic stroke.
sICH, In-hospital death, discharge modified Rankin scale score, and other life-threatening systemic hemorrhages.
Of 409 673 participants, 321 819 patients (mean [SD] age, 68.6 [15.1] years; 164 587 female [51.1%]) who were hospitalized with acute ischemic stroke and treated with IV-tPA were included in the analysis. The rate of sICH was 2.9% (5200 of 182 344), 3.8% (4457 of 117 670), and 4.1% (893 of 21 805) among patients treated with no antiplatelet therapy, single antiplatelet therapy (SAPT), and DAPT, respectively (P < .001). In adjusted analyses after propensity score subclassification, both SAPT (odds ratio [OR], 1.13; 95% CI, 1.07-1.19) and DAPT (OR, 1.28; 95% CI, 1.14-1.42) were associated with increased risks of sICH. Prestroke antiplatelet medications were associated with lower odds of discharge mRS score of 2 or less compared with no medication (SAPT OR, 0.92; 95% CI, 0.90-0.95; DAPT OR, 0.94; 95% CI, 0.88-0.98). Results of a subgroup analysis of patients taking DAPT exposed to aspirin-clopidogrel vs aspirin-ticagrelor combination therapy were not significant (OR, 1.35; 95% CI, 0.84-1.86).
Prestroke DAPT was associated with a significantly elevated risk of sICH among patients with ischemic stroke who were treated with thrombolysis; however, the absolute increase in risk was small. Patients exposed to antiplatelet medications did not have excess sICH compared with landmark trials, which demonstrated overall clinical benefit of thrombolysis therapy for acute ischemic stroke.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>38767894</pmid><doi>10.1001/jamaneurol.2024.1312</doi></addata></record> |
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| source | American Medical Association Journals |
| subjects | Aspirin Clinical trials Clopidogrel Data analysis Exposure Hemorrhage Hospitals Ischemia Patients Risk analysis Stroke Subgroups Therapy Thrombolysis |
| title | Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis |
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