TY - JOUR
T1 - Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke
T2 - a systematic review and meta-analysis
AU - Tsivgoulis, Georgios
AU - Katsanos, Aristeidis H.
AU - Zand, Ramin
AU - Sharma, Vijay K.
AU - Köhrmann, Martin
AU - Giannopoulos, Sotirios
AU - Dardiotis, Efthymios
AU - Alexandrov, Anne W.
AU - Mitsias, Panayiotis D.
AU - Schellinger, Peter D.
AU - Alexandrov, Andrei V.
N1 - Funding Information:
The risk of bias in the included studies is summarized in Supplemental Figures IA and IB. Overall, a low risk of bias was found within individual studies, except for the uncertainty of bias related to the funding source. Half of the study protocols reported financial support by the pharmaceutical companies with a clear conflict of interest on the therapy under consideration in each study [, , ], while the remaining studies reported funding from public and institutional resources [, , , ]. The risk of performance bias was considered unclear in three out of seven included trials due to the lack of blinding of study participants and investigators and the use of blinding only in the endpoint evaluation (PROBE design) [, , ]. The risk of detection bias was considered high only for the outcome of early vessel recanalization in only one trial reporting a non-blinded assessment of early recanalization on transcranial Doppler ultrasonography from sonographers who were aware of patients’ group assignment [] and unclear in another trial as investigators assessing sICH had knowledge of treatment assignment [].
Publisher Copyright:
© 2017, Springer-Verlag Berlin Heidelberg.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Since there are contradictory data regarding the association of antiplatelet pretreatment (AP) with safety and efficacy outcomes of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), we conducted a systematic review and meta-analysis of available randomized-controlled clinical trials (RCTs) to investigate the association of AP with outcomes of AIS patients treated with intravenous alteplase. The outcome events of interest included symptomatic intracranial hemorrhage (sICH), fatal ICH, complete recanalization (CR), 3-month favorable functional outcome (FFO, mRS score 0–1), 3-month functional independence (FI, mRS score 0–2), and mortality. The corresponding odds ratios (ORs) were calculated for all the outcome events using random-effects model. The adjusted age and admission NIHSS OR (ORadjusted) were also estimated for all available outcomes. We included 7 RCTs (4376 patients, 33.7% with AP). In unadjusted analyses, AP was associated with higher likelihood of sICH (OR = 1.89, 95% CI 1.40–2.56), death (OR = 1.59, 95% CI 1.24–2.03), and lower likelihood of 3-month FI (OR = 0.69, 95% CI 0.56–0.85). No association was detected between AP and fatal ICH (OR = 1.53, 95% CI 0.75–3.15), 3-month FFO (OR = 0.79, 95% CI 0.58–1.07), and CR (OR = 0.64, 95% CI 0.04–11.66). After adjustment for age and admission stroke severity, AP was not related to sICH (ORadjusted = 1.67, 95% CI 0.75–3.72), 3-month FI (ORadjusted = 0.88, 95% CI 0.54–1.42), or death (ORadjusted = 1.01, 95% CI 0.55–1.86) in adjusted analyses. In conclusion, after adjusting for confounders, AP was not associated with a higher risk of sICH and worse 3-month functional outcome in AIS treated with intravenous alteplase. Antiplatelet intake prior to tPA-bolus should not be used as a reason to withhold or lower alteplase dose in AIS patients treated with IVT.
AB - Since there are contradictory data regarding the association of antiplatelet pretreatment (AP) with safety and efficacy outcomes of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), we conducted a systematic review and meta-analysis of available randomized-controlled clinical trials (RCTs) to investigate the association of AP with outcomes of AIS patients treated with intravenous alteplase. The outcome events of interest included symptomatic intracranial hemorrhage (sICH), fatal ICH, complete recanalization (CR), 3-month favorable functional outcome (FFO, mRS score 0–1), 3-month functional independence (FI, mRS score 0–2), and mortality. The corresponding odds ratios (ORs) were calculated for all the outcome events using random-effects model. The adjusted age and admission NIHSS OR (ORadjusted) were also estimated for all available outcomes. We included 7 RCTs (4376 patients, 33.7% with AP). In unadjusted analyses, AP was associated with higher likelihood of sICH (OR = 1.89, 95% CI 1.40–2.56), death (OR = 1.59, 95% CI 1.24–2.03), and lower likelihood of 3-month FI (OR = 0.69, 95% CI 0.56–0.85). No association was detected between AP and fatal ICH (OR = 1.53, 95% CI 0.75–3.15), 3-month FFO (OR = 0.79, 95% CI 0.58–1.07), and CR (OR = 0.64, 95% CI 0.04–11.66). After adjustment for age and admission stroke severity, AP was not related to sICH (ORadjusted = 1.67, 95% CI 0.75–3.72), 3-month FI (ORadjusted = 0.88, 95% CI 0.54–1.42), or death (ORadjusted = 1.01, 95% CI 0.55–1.86) in adjusted analyses. In conclusion, after adjusting for confounders, AP was not associated with a higher risk of sICH and worse 3-month functional outcome in AIS treated with intravenous alteplase. Antiplatelet intake prior to tPA-bolus should not be used as a reason to withhold or lower alteplase dose in AIS patients treated with IVT.
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U2 - 10.1007/s00415-017-8520-1
DO - 10.1007/s00415-017-8520-1
M3 - Article
C2 - 28550481
AN - SCOPUS:85019675225
SN - 0340-5354
VL - 264
SP - 1227
EP - 1235
JO - Deutsche Zeitschrift fur Nervenheilkunde
JF - Deutsche Zeitschrift fur Nervenheilkunde
IS - 6
ER -