Abstract Details

Title Are Antiplatelet Agents within 24 Hours of Intra-Arterial Thrombolysis in Acute Ischemic Stroke Patients Safe?

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 257

Objective

Background BACKGROUND: Current American Heart Association guidelines recommend holding all antiplatelet use within 24 hours of thrombolytic use because of concerns regarding an increased risk of ICH. The increased use of emergent thrombectomy, angioplasty, and stent placement in endovascular treatment of acute stroke has prompted a reconsideration of antiplatelet use within 24-hour period.

Design/Methods DESIGN/METHODS: All endovascular treated acute ischemic stroke patients identified over a 6-year period. Patients' clinical characteristics, timing of antiplatelet agents, rates of poor outcome at discharge (modified Rankin score [mRS] of >3) and ICH were obtained and analyzed.

Results RESULTS: Total 115 patients that underwent IA thrombolysis, 65 patients (mean age 60 ± 16.4; 60% men) were started on antiplatelet agents within 24 hours. 43 (66%) patients were started on single antiplatelet, 19 (29%) on dual antiplatelet, and 3 (4.7%) on triple antiplatelet agents within 24 hours of IA thrombolysis. The proportion of patients with admission NIHSS score>20 was similar in patients who received antiplatelet agents within 24 hours versus those who received them after 24 hours (22% versus 24%, p=0.8) Compared with patients in whom antiplatelets were started after 24 hours, there was no significant difference in the rates of post-procedure ICH (20% versus 9%, p=0.09), in-hospital mortality (12% versus 12%, p=0.9)and the rates of poor outcomes (64% versus 71%, p=0.5) between the two groups.

Conclusions CONCLUSIONS: Despite the existing recommendation advising against the initiation of antiplatelet agents within 24 hours of thrombolysis, there seems to be no significant risk of increased ICH or mortality with such a practice in IA thrombolysis cases. Larger prospective studies are needed to identify the benefit of early initiation of antiplatelet agents.

Authors/Disclosures
PRESENTER	No disclosure on file
Ameer Hassan, DO (Valley Baptist Medical Center)	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
	No disclosure on file
Basit Rahim, MD (Virginia Commonwealth University Health System)	No disclosure on file
	No disclosure on file
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

��ɫ��

��ɫ��