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Abstract
Objective: To compare clinical outcomes of patients who received early initiation (<24 hours) of antithrombotics with those who received standard management (antithrombotics administered ≥24 hours).
Methods: A total of 712 patients who had an acute ischemic stroke and underwent IV or endovascular (intra-arterial [IA]) recanalization between July 2007 and March 2015 were selected from a prospective clinical registry. Antithrombotics were initiated by an individual clinical decision. We systemically gathered information regarding the exact timing of antithrombotic initiation from a database of the electronic barcode medication administration system.
Results: The recanalization treatment cases included in this study comprised 34% (n = 243) IV only, 32% (n = 229) IA only, and 34% (n = 240) combined IV-IA strategies. Antithrombotics were administered within 24 hours in 64% (n = 456) of the patients. Earlier initiation of antithrombotics was associated with decreased odds of having any hemorrhages (adjusted odds ratio 0.56; 95% confidence interval 0.35–0.89), but was not associated with symptomatic hemorrhages (0.85; 0.35–2.10) or modified Rankin Scale scores of 0–1 at 3 months after stroke (1.09; 0.75–1.59). Ultra-early initiation (<12 hours) did not increase the odds of hemorrhagic transformation (0.26; 0.12–0.52). The effects of earlier antithrombotics on the clinical outcomes were not significantly modified by the modality of recanalization treatment.
Conclusions: In our retrospective analysis of a prospective registry, early antithrombotic (within 24 hours after initiation) administration did not increase hemorrhages after recanalization treatment. Early antithrombotic therapy may be advantageous for a subset of stroke patients despite the current guidelines.
GLOSSARY
- CI=
- confidence interval;
- END=
- early neurologic deterioration;
- HT=
- hemorrhagic transformation;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received January 15, 2016.
- Accepted in final form May 26, 2016.
- © 2016 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Reply by Gallerini et al. to the Authors
- Re: Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment
- Author reply to the comment by Gallerini et al.
- Early use of antithrombotics after recanalization treatment in ischemic stroke: Who are the candidates?
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