Prior antiplatelet is associated with better outcome for acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

Background: There has been limited evidence and inconsistent results on the safety and effectiveness of prior antiplatelet (PA) use for acute ischemic stroke (AIS) patients treated with endovascular treatment (EVT). Methods: We prospectively enrolled consecutive patients from two comprehensive stroke centers in China from June 2015 to June 2019. The efficacy outcomes were vascular recanalization rate, early neurological function improvement (24-hour NIHSS decreased ≥4), poor prognosis at 90 days (mRS 3-6), and death at 90 days. The safety outcomes were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Univariate and multivariate logistic regression was performed with SPSS 22.0. Results: A total of 298 AIS patients were included. Of them, 54 (18.1%) patients were taking antiplatelet agents before stroke. PA (OR=0.40, 95% CI 0.16-0.98, p=0.046) significantly reduced the three-month death, and this difference persisted after adjusting for clinical confounders (adjusted OR =0.29, 95% CI 0.10-0.83, p=0.021). PA (adjusted OR=0.52, 95% CI 0.26-1.06, p=0.075) was not significantly associated with three-month death or disability. There were no significant differences in successful recanalization, early neurological improvement, ICH and sICH between groups. Conclusions: For AIS patients with EVT, prior antiplatelet is safe and may reduce the risk of death at three months.