Dual Antiplatelet Therapy after Intravenous Thrombolysis for Acute Minor Ischemic Stroke

Eur Neurol. 2019;82(4-6):93-98. doi: 10.1159/000505241. Epub 2020 Jan 8.

Abstract

Objective: To verify the efficacy and safety of dual antiplatelet therapy after intravenous thrombolysis for acute minor ischemic stroke (AMIS).

Methods: AMIS patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from January to October 2018 were retrospectively analyzed and divided into the aspirin (ASP) and ASP + clopidogrel (ASP-CLO) groups based on the type of antiplatelet therapy to compare the rates of good clinical outcome, symptomatic intracranial hemorrhage (SICH) after thrombolysis, and mortality in 90 days.

Results: A total of 207 patients were included (group ASP, 105 patients; group ASP-CLO, 102 patients). There was no significant difference in the baseline clinical data between the 2 groups. The -90-day modified Rankin scale scores (66.7 vs. 82.4%, p = 0.009) showed a statistically significant difference, but SICH (1.0 vs. 1.0%, p = 0.917) and 90-day mortality (1.9 vs. 1.0%, p = 0.585) showed no significant difference between the 2 groups.

Conclusions: Short-term (21 days) dual antiplatelet therapy after rt-PA intravenous thrombolysis for AMIS can improve the prognosis, reduce the risk of stroke recurrence, without increasing the risk of bleeding and mortality.

Keywords: Acute minor ischemic stroke; Dual antiplatelet therapy; Intravenous thrombolysis; Safety.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aspirin / therapeutic use
  • Brain Ischemia / drug therapy
  • Clopidogrel / therapeutic use
  • Dual Anti-Platelet Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Prognosis
  • Retrospective Studies
  • Stroke / drug therapy*
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Tissue Plasminogen Activator
  • Aspirin