Safety and Efficacy of Baseline Antiplatelet Treatment in Patients Undergoing Mechanical Thrombectomy for Ischemic Stroke

by Selleckchem | Sep 01 2023

Purpose: Baseline use of antiplatelet medication before mechanical thrombectomy (MT) for acute ischemic stroke (AIS) can provide benefit on reperfusion and clinical outcome, but could also carry an increased risk of intracranial hemorrhage (ICH). This nationwide study investigates the safety and efficacy of baseline antiplatelet treatment in AIS patients undergoing MT.

Materials and methods: All consecutive AIS patients treated with MT with and without intravenous thrombolysis (IVT) between January 2012 and December 2019 in all centers performing MT nationwide were reviewed. Data were prospectively collected in national registries (SITS-TBY, RES-Q). Primary outcome was functional independence (modified Rankin Scale 0-2) at three months, secondary outcome was ICH.

Results: Out of 4351 patients undergoing MT, 1750 (40%) and 666 (15%) were excluded due to missing data in the functional independence and ICH outcome cohort, respectively. In the functional independence cohort (2601), 771 (30%) patients received antiplatelets before MT. Favorable outcome did not differ in any antiplatelets group, aspirin, and clopidogrel group when compared to no antiplatelets: OR 1.00 (95%CI (0.84-1.20)), OR 1.05 (95%CI (0.86-1.27)), and OR 0.88 (95%CI (0.55-1.41)), respectively. In the ICH cohort (3685), 1095 (30%) patients received antiplatelets before MT. Rates of ICH did not increase in any treatment option when compared to no antiplatelets: OR 1.03 (95%CI (0.87-1.21)), OR 0.99 (95%CI (0.83-1.18)), OR 1.10 (95%CI (0.82-1.47)), and OR 1.43 (95%CI (0.87-2.33)), respectively.

Conclusion: Antiplatelet monotherapy prior to MT did not improve functional independence nor increase risk of ICH.

Comments:

The purpose of this nationwide study was to evaluate the safety and efficacy of baseline antiplatelet medication in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). The study aimed to assess whether the use of antiplatelets before MT could improve reperfusion and clinical outcomes, while also investigating the potential risk of intracranial hemorrhage (ICH).

The researchers reviewed data from all consecutive AIS patients who underwent MT with or without intravenous thrombolysis (IVT) between January 2012 and December 2019 in all centers performing MT nationwide. The data were collected prospectively in national registries (SITS-TBY, RES-Q). The primary outcome measure was functional independence, assessed using the modified Rankin Scale (0-2) at three months. The secondary outcome measure was the occurrence of ICH.

Out of the 4,351 patients who underwent MT, 1,750 (40%) and 666 (15%) were excluded from the functional independence and ICH outcome cohorts, respectively, due to missing data. In the functional independence cohort (2,601 patients), 771 (30%) received antiplatelets before MT. The study found that the rates of favorable functional outcomes did not differ significantly between any of the antiplatelet groups (including aspirin and clopidogrel) when compared to the group that did not receive any antiplatelets. The odds ratios (OR) for functional independence were 1.00 (95% confidence interval (CI) 0.84-1.20), 1.05 (95% CI 0.86-1.27), and 0.88 (95% CI 0.55-1.41) for the different antiplatelet groups, respectively, compared to the no antiplatelet group.

In the ICH cohort (3,685 patients), 1,095 (30%) received antiplatelets before MT. The study found that the rates of ICH did not increase significantly in any of the treatment groups when compared to the group that did not receive any antiplatelets. The odds ratios (OR) for ICH were 1.03 (95% CI 0.87-1.21), 0.99 (95% CI 0.83-1.18), 1.10 (95% CI 0.82-1.47), and 1.43 (95% CI 0.87-2.33) for the different antiplatelet groups, respectively, compared to the no antiplatelet group.

In conclusion, the study found that the use of antiplatelet monotherapy prior to MT did not improve functional independence in AIS patients, nor did it increase the risk of intracranial hemorrhage.