Why the study?
Does acetylsalicylic acid pretreatment or subsequent heparin therapy increase the risk of early intracranial hemorrhage in acute ischemic stroke patients receiving systemic thrombolysis?
Does acetylsalicylic acid pretreatment or subsequent heparin therapy increase the risk of early intracranial hemorrhage in acute ischemic stroke patients receiving systemic thrombolysis?
Prior use of acetylsalicylic acid does not increase the risk of early symptomatic intracranial bleeding in acute ischemic stroke patients undergoing systemic thrombolysis, even with subsequent heparin use.
Answers are grounded in this paper and cite their sources.
ASA pretreatment and heparin were not associated with early hemorrhage after thrombolysis; hypothesis-generating and should not yet change practice.
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.
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Schmülling et al. (2003) studied this question.
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