PMID- 18332238
OWN - NLM
STAT- MEDLINE
DCOM- 20080715
LR  - 20090316
IS  - 1538-3687 (Electronic)
IS  - 0003-9942 (Linking)
VI  - 65
IP  - 5
DP  - 2008 May
TI  - Safety of antiplatelet therapy prior to intravenous thrombolysis in acute 
      ischemic stroke.
PG  - 607-11
LID - 10.1001/archneur.65.5.noc70077 [doi]
AB  - BACKGROUND: There is some uncertainty whether prior use of antiplatelet (AP) 
      drugs increases the risk of symptomatic intracerebral hemorrhage (SICH) and 
      influences functional outcome in patients with ischemic stroke treated with 
      intravenous thrombolysis. OBJECTIVE: To assess whether prior use of AP drugs is 
      related to outcome following intravenous tissue plasminogen activator therapy in 
      patients with ischemic stroke. DESIGN, SETTING, AND PATIENTS: A single-center 
      prospective observational cohort study of the relation between prior AP therapy, 
      occurrence of SICH, and functional outcome of consecutive patients with ischemic 
      stroke undergoing intravenous thrombolysis with tissue plasminogen activator in a 
      university hospital between April 1, 2002, and November 30, 2006. MAIN OUTCOME 
      MEASURES: The occurrence of SICH and favorable outcome reflecting independence 
      defined as a modified Rankin Scale score of 2 or lower at 3 months. RESULTS: Of 
      the 301 patients who received intravenous tissue plasminogen activator, 89 used 
      AP drugs prior to thrombolysis. Symptomatic intracerebral hemorrhage occurred in 
      12 patients (13.5%; 95% confidence interval, 7.8%-22.3%) who had received AP 
      drugs and in 6 patients (2.8%; 95% confidence interval, 1.2%-6.2%) without prior 
      AP therapy (P = .001). Multivariate analysis revealed that prior AP therapy was 
      an independent predictor of SICH (odds ratio, 6.0; 95% confidence interval, 
      2.0-17.1). Nonetheless, prior AP therapy was independently associated with a 
      favorable outcome (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). 
      CONCLUSION: Despite a higher incidence of SICH, the net benefit of intravenous 
      tissue plasminogen activator therapy for acute ischemic stroke was greater in 
      patients using AP drugs.
FAU - Uyttenboogaart, Maarten
AU  - Uyttenboogaart M
AD  - Department of Neurology, University Medical Center Groningen, University of 
      Groningen, Groningen, The Netherlands. m.uyttenboogaart@neuro.umcg.nl
FAU - Koch, Marcus W
AU  - Koch MW
FAU - Koopman, Karen
AU  - Koopman K
FAU - Vroomen, Patrick C A J
AU  - Vroomen PC
FAU - De Keyser, Jacques
AU  - De Keyser J
FAU - Luijckx, Gert-Jan
AU  - Luijckx GJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080310
PL  - United States
TA  - Arch Neurol
JT  - Archives of neurology
JID - 0372436
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
CIN - Arch Neurol. 2008 May;65(5):575-6. PMID: 18474730
CIN - Nat Clin Pract Neurol. 2008 Sep;4(9):474-5. PMID: 18665145
MH  - Aged
MH  - Brain Ischemia/*drug therapy/epidemiology/prevention & control
MH  - Causality
MH  - Cerebral Hemorrhage/*chemically induced/epidemiology/prevention & control
MH  - Cohort Studies
MH  - Comorbidity
MH  - Data Interpretation, Statistical
MH  - Drug Synergism
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fibrinolytic Agents/*administration & dosage/adverse effects
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Stroke/*drug therapy/epidemiology/prevention & control
MH  - Tissue Plasminogen Activator/administration & dosage/adverse effects
MH  - Treatment Outcome
EDAT- 2008/03/12 09:00
MHDA- 2008/07/17 09:00
CRDT- 2008/03/12 09:00
PHST- 2008/03/12 09:00 [pubmed]
PHST- 2008/07/17 09:00 [medline]
PHST- 2008/03/12 09:00 [entrez]
AID - 65.5.noc70077 [pii]
AID - 10.1001/archneur.65.5.noc70077 [doi]
PST - ppublish
SO  - Arch Neurol. 2008 May;65(5):607-11. doi: 10.1001/archneur.65.5.noc70077. Epub 
      2008 Mar 10.