Key result
Early aspirin after thrombolysis increases sICH-related neurological deterioration nearly ~4-fold in acute ischemic stroke.
Why the study?
Aspirin early after intravenous thrombolysis in acute ischemic stroke increases the risk of symptomatic intracranial hemorrhage without influencing 3-month functional outcome, but its effect on early neurological deterioration was unclear.
Does the addition of aspirin to intravenous thrombolysis affect the risk of early neurological deterioration in patients with acute ischemic stroke?
RCT (n=640)
Does the addition of aspirin to intravenous thrombolysis affect the risk of early neurological deterioration in patients with acute ischemic stroke?
Odds Ratio: 3.73 (95% CI 1.03–13.49)
The addition of aspirin early after intravenous thrombolysis in acute ischemic stroke increases the risk of early neurological deterioration due to symptomatic intracranial hemorrhage without providing an early antithrombotic benefit.
Early aspirin after thrombolysis raises SICH risk without 3-month benefit; post hoc analysis leaves open any effect on END.
BACKGROUND AND PURPOSE: Aspirin early after intravenous thrombolysis in acute ischemic stroke increases the risk of symptomatic intracranial hemorrhage (SICH), without influencing functional outcome at 3 months. The effect of aspirin on early neurological deterioration (END) was explored as a post hoc analysis of the randomized Antiplatelet Therapy in Combination With Recombinant t-PA Thrombolysis in Ischemic Stroke (ARTIS) trial. METHODS: END, defined as a ≥4 points National Institutes of Health Stroke Scale worsening ≤24 hours after intravenous thrombolysis, was categorized into SICH (ENDSICH) and cerebral ischemia (ENDCI). Multinomial logistic regression was used to assess the effect of aspirin on END. RESULTS: Of the 640 patients, 31 patients (4.8%) experienced END (14 ENDSICH, 17 ENDCI). Aspirin increased the risk of ENDSICH (odds ratio, 3.73; 95% confidence interval, 1.03-13.49) but not of ENDCI (odds ratio, 1.14; 95% confidence interval, 0.44-3.00). After adjustment for other explanatory variables, the association between aspirin and ENDSICH remained significant. CONCLUSIONS: In this trial, there is no evidence of an early antithrombotic effect from the addition of aspirin to intravenous thrombolysis in acute ischemic stroke.
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Zinkstok et al. (2014) conducted an RCT in acute ischemic stroke (n=640). Aspirin was evaluated on Early neurological deterioration due to symptomatic intracranial hemorrhage (ENDSICH) (OR 3.73, 95% CI 1.03-13.49). Early aspirin after intravenous thrombolysis in acute ischemic stroke increased the risk of early neurological deterioration due to symptomatic intracranial hemorrhage (OR 3.73; 95% CI 1.03-13.49).
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