PMID- 20861622
OWN - NLM
STAT- MEDLINE
DCOM- 20110210
LR  - 20181201
IS  - 1421-9786 (Electronic)
IS  - 1015-9770 (Linking)
VI  - 30
IP  - 5
DP  - 2010
TI  - Does current oral antiplatelet agent or subtherapeutic anticoagulation use have 
      an effect on tissue-plasminogen-activator-mediated recanalization rate in 
      patients with acute ischemic stroke?
PG  - 508-13
LID - 10.1159/000319029 [doi]
AB  - OBJECTIVE: Our goal is to assess if current antiplatelet (AP) use has an effect 
      on recanalization rate and outcome in acute stroke patients. METHODS: We 
      conducted a retrospective analysis of acute stroke patients who received 
      intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and had 
      transcranial Doppler examination within 3 h of symptom onset. The TCD findings 
      were interpreted using the Thrombolysis in Brain Ischemia flow grading system as 
      persistent arterial occlusion, reocclusion or complete recanalization. Complete 
      recanalization was defined as established Thrombolysis in Brain Ischemia 4 or 5 
      within 2 h of IV rt-PA. The patients were divided based on their current use of 
      AP agents. Comparisons were made between the different groups based on 
      recanalziation rate, reocclusion and good long-term outcome (mRS </= 2) using chi(2) 
      test. Multiple regression analysis was used to identify AP use as a predictor for 
      recanalization and outcome including symptomatic intracranial hemorrhage after 
      controlling for age, baseline NIHSS score, time to treatment, previous vascular 
      event, hypertension and diabetes mellitus. RESULTS: Two hundred and eighty-four 
      patients were included; 154 (54%) males, 130 (46%) females, with a mean age of 
      69.5 +/- 13 years. The median baseline NIHSS score was 16 +/- 5. The median time to 
      TCD examination was 131 +/- 38 min from symptom onset. The median time to IV rt-PA 
      was 140 +/- 34 min. One hundred eighty patients were not on AP prior to their 
      stroke, 76 were on aspirin, 15 were on clopidogrel, 2 were on 
      aspirin-dipyridamole combination, 2 were on both aspirin and clopidogrel, and 9 
      patients on subtherapeutic coumadin. In patients who were naive to AP, 68/178 
      (38.2%) had complete recanalization, whereas in the AP group, 25/91 (28%) had 
      complete recanalization. Patients on aspirin alone had a lower recanalization 
      rate (16/72) as compared to those not on AP (22 vs. 39%) (p = 0.017), while those 
      on clopidogrel had higher rates of complete recanalization (9/19, 60%). There was 
      no difference in the rate of symptomatic intracranial hemorrhages in patients on 
      AP agents as compared to those not on AP (9/180, 5% vs. 9/95, 9.5%) (p = 0.13). A 
      good long-term outcome (mRS </=2) was achieved in 85/160 (53%) of the patients 
      naive to AP and in 33/84 (39%) of the patients on AP (p = 0.035). In multiple 
      regression, AP use was not a predictor of either recanalization rate (p = 0.057) 
      or good outcome (p = 0.27). CONCLUSIONS: No correlation was found between AP use 
      and recanalization rate and good outcome in patients with acute stroke who 
      received IV rt-PA treatment. Prior AP use should not defer patients from 
      receiving IV rt-PA treatment in an acute stroke setting.
CI  - Copyright (c) 2010 S. Karger AG, Basel.
FAU - Ibrahim, Mohamed M
AU  - Ibrahim MM
AD  - Department of Medicine (Neurology), University of Alberta, 8440 112th Avenue, 
      Edmonton, AB, Canada.
FAU - Sebastian, Joseph
AU  - Sebastian J
FAU - Hussain, Muhammad
AU  - Hussain M
FAU - Al-Hussain, Fawaz
AU  - Al-Hussain F
FAU - Uchino, Ken
AU  - Uchino K
FAU - Molina, Carlos
AU  - Molina C
FAU - Khan, Khurshid
AU  - Khan K
FAU - Demchuk, Andrew M
AU  - Demchuk AM
FAU - Alexandrov, Andrei V
AU  - Alexandrov AV
FAU - Saqqur, Maher
AU  - Saqqur M
CN  - CLOTBUST Investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20100922
PL  - Switzerland
TA  - Cerebrovasc Dis
JT  - Cerebrovascular diseases (Basel, Switzerland)
JID - 9100851
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - A74586SNO7 (Clopidogrel)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Aspirin/administration & dosage/therapeutic use
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Humans
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage/*therapeutic use
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Stroke/*drug therapy
MH  - Thrombolytic Therapy/*methods
MH  - Ticlopidine/administration & dosage/analogs & derivatives/therapeutic use
MH  - Tissue Plasminogen Activator/administration & dosage/adverse effects/*therapeutic 
      use
MH  - Treatment Outcome
MH  - Warfarin/administration & dosage/therapeutic use
EDAT- 2010/09/24 06:00
MHDA- 2011/02/11 06:00
CRDT- 2010/09/24 06:00
PHST- 2009/12/07 00:00 [received]
PHST- 2010/06/28 00:00 [accepted]
PHST- 2010/09/24 06:00 [entrez]
PHST- 2010/09/24 06:00 [pubmed]
PHST- 2011/02/11 06:00 [medline]
AID - 000319029 [pii]
AID - 10.1159/000319029 [doi]
PST - ppublish
SO  - Cerebrovasc Dis. 2010;30(5):508-13. doi: 10.1159/000319029. Epub 2010 Sep 22.