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September 06, 2016; 87 (10) Article

Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment

Han-Gil Jeong, Beom Joon Kim, Mi Hwa Yang, Moon-Ku Han, Hee-Joon Bae, Seung-Hoon Lee
First published August 12, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003083
Han-Gil Jeong
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Beom Joon Kim
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Mi Hwa Yang
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Moon-Ku Han
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Hee-Joon Bae
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Seung-Hoon Lee
From the Department of Neurology (H.-G.J., S.-H.L.), Seoul National University Hospital; and Department of Neurology and Cerebrovascular Center (B.J.K., M.H.Y., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonngi-do, Republic of Korea.
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Citation
Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment
Han-Gil Jeong, Beom Joon Kim, Mi Hwa Yang, Moon-Ku Han, Hee-Joon Bae, Seung-Hoon Lee
Neurology Sep 2016, 87 (10) 996-1002; DOI: 10.1212/WNL.0000000000003083

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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
    • Simone Gallerini, MD, Misericordia Hospital, Grosseto, Italysimone.gallerini@uslsudest.toscana.it
    • Luca Marsili, Grosseto and Rome, Italy; Manuele Bartalucci, Grosseto, Italy; Roberto Marconi, Grosseto, Italy
    Submitted November 07, 2016
  • Re: Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment
    • Chen Wei, Department of Neurosurgery, West China Hospital of Sichuan UniversityCHN02011@163.com
    • Chen Jing, Wang Li, Liu Fujun, Chen Da Chengdu, Sichuan, China
    Submitted October 31, 2016
  • Author reply to the comment by Gallerini et al.
    • Beom Joon Kim, Assistant Professor, Department of Neurology and Cerebrovascular Center, Seoul National University Bundang HospitalKim.BJ.Stroke@gmail.com
    Submitted October 17, 2016
  • Early use of antithrombotics after recanalization treatment in ischemic stroke: Who are the candidates?
    • Simone Gallerini, MD, Misericordia Hospital, Grosseto, Italysimone.gallerini@uslsudest.toscana.it
    • Luca Marsili, Grosseto and Rome, Italy; Manuele Bartalucci, Grosseto, Italy; Roberto Marconi, Grosseto, Italy
    Submitted October 12, 2016
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