Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke

Susanne Schmülling; Jobst Rudolf; Timm Strotmann-Tack; Martin Grond; Susanne Schneweis; Jan Sobesky; Alexander Thiel; Wolf-Dieter Heiss

doi:10.1159/000071114

Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke

Cerebrovasc Dis. 2003;16(3):183-90. doi: 10.1159/000071114.

Authors

Susanne Schmülling¹, Jobst Rudolf, Timm Strotmann-Tack, Martin Grond, Susanne Schneweis, Jan Sobesky, Alexander Thiel, Wolf-Dieter Heiss

Affiliation

¹ Department of Neurology, University of Cologne, Cologne, Germany.

PMID: 12865603
DOI: 10.1159/000071114

Abstract

Background: The risk of intracerebral hemorrhage in systemic thrombolysis for acute ischemic stroke after acetylsalicylic acid (ASA) pretreatment or with subsequent heparin is controversially discussed.

Methods: 300 consecutive stroke patients were treated with recombinant tissue-type plasminogen activator (rt-PA) in a prospective open study (92 pretreated with ASA, 202 ASA nonusers) with 3 months of follow-up. After thrombolysis, 122 patients received low-dose, 153 patients high-dose heparin.

Results: Logistic regression analysis showed no relationship of hemorrhagic complications within the first 48 h to ASA pretreatment (p = 0.15), or heparin application (p = 0.38), but dependency on stroke severity (NIHSS) at baseline (p = 0.01).

Conclusion: ASA pretreatment does not increase the risk of symptomatic bleeding after systemic thrombolysis with rt-PA, even if thrombolysis is followed by anticoagulation.

Publication types

Clinical Trial
Clinical Trial, Phase IV

MeSH terms

Acute Disease
Aged
Aspirin / administration & dosage
Aspirin / adverse effects*
Aspirin / therapeutic use*
Brain Ischemia / complications*
Brain Ischemia / drug therapy*
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Fibrinolytic Agents / administration & dosage
Fibrinolytic Agents / adverse effects*
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Heparin / administration & dosage
Heparin / adverse effects*
Heparin / therapeutic use*
Humans
Intracranial Hemorrhages / etiology*
Male
Middle Aged
Outcome Assessment, Health Care
Prospective Studies
Risk Factors
Stroke / drug therapy*
Thrombolytic Therapy / adverse effects*
Time Factors
Tissue Plasminogen Activator / administration & dosage
Tissue Plasminogen Activator / adverse effects*
Tissue Plasminogen Activator / therapeutic use*

Substances

Fibrinolytic Agents
Heparin
Tissue Plasminogen Activator
Aspirin