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

Publication at Central Library of Charles University, Faculty of Medicine in Pilsen, Second Faculty of Medicine, Third Faculty of Medicine, Faculty of Medicine in Hradec Králové |


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.