Key result
Streptokinase plus aspirin significantly increased early case fatality compared to streptokinase alone in patients with acute ischemic stroke (OR 2.1; 95% CI 1.2-3.6).
Why the study?
Does the combination of streptokinase and aspirin increase the risk of death and cerebral hemorrhage compared to streptokinase alone in patients with acute ischemic stroke?
RCT (n=313)
Yes
Does the combination of streptokinase and aspirin increase the risk of death and cerebral hemorrhage compared to streptokinase alone in patients with acute ischemic stroke?
The combination of aspirin and streptokinase in acute ischemic stroke significantly increases early mortality and hemorrhagic complications compared to streptokinase alone.
Answers are grounded in this paper and cite their sources.
Associated with higher early fatality; leaves open whether this reflects confounding or true harm in acute ischemic stroke.
BACKGROUND: Thrombolytic therapy improves the functional outcome in acute ischemic stroke, but the risk of death and cerebral hemorrhage remains high. Aspirin given together with a thrombolytic agent may worsen the risk-to-benefit ratio. We performed a further Multicenter Acute Stroke Trial-Italy (MAST-I) which is the only randomized, controlled trial that has tested the effect of this combination to evaluate the risk of aspirin use plus streptokinase. PATIENTS AND METHODS: We made a post hoc analysis of the MAST-I results comparing streptokinase plus aspirin (156 patients) with streptokinase alone (157 patients). We evaluated the risk of death and cerebral hemorrhage. RESULTS: The combined regimen significantly increased early case fatality from day 3-10 (53 vs. 30; OR 2.1; CI 1.2-3.6). The death excess was solely due to treatments and was not explained by the main prognostic predictors (multifactorial analysis). The cause of death in the combination group was mainly cerebral (42 vs. 24; OR 2.0; CI 1.3-3.7) and associated with hemorrhagic transformation (22 vs. 11; OR 2.2; CI 1.0-5.0). The rate of stroke reoccurrence was not increased in patients treated with streptokinase alone (15 vs. 11; OR 1.4; CI 0.6-3.4). CONCLUSIONS: Stroke patients treated with streptokinase plus aspirin have an increased risk of early death, probably due to cerebral hemorrhagic complications. Whenever thrombolytics are chosen for acute stroke treatment, aspirin and other antiplatelet agents should be avoided.
No takes yet. Share an insight, caveat, or question.
Ciccone et al. (2000) conducted an RCT in Acute ischemic stroke (n=313). Streptokinase plus aspirin vs. Streptokinase alone was evaluated on Early case fatality from day 3-10 (OR 2.1, 95% CI 1.2-3.6). Streptokinase plus aspirin significantly increased early case fatality compared to streptokinase alone in patients with acute ischemic stroke (OR 2.1; 95% CI 1.2-3.6).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: