Association of prior antiplatelet therapy with outcomes in acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

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). This study aimed to evaluate the association of prior antiplatelet use with efficacy and safety outcomes in AIS patients undergoing EVT. 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 analyses were performed with SPSS 22.0. 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) was significantly associated with lower three-month mortality, and this association persisted after adjusting for clinical confounders (adjusted OR=0.28, 95% CI 0.11-0.87, p =0.014). PA (adjusted OR=0.50, 95% CI 0.24-1.04, p =0.063) 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. For AIS patients with EVT, prior antiplatelet use was associated with lower 3-month mortality. However, no significant association was observed between prior antiplatelet therapy and poor functional outcome defined as mRS 3–6.