Impact of Prior Antithrombotic Therapy on Safety and Outcomes of Endovascular Therapy in Large-Core Acute Ischemic Stroke

BACKGROUND AND PURPOSE: Evidence on whether prior antithrombotic drug (ATD) use affects outcomes after endovascular therapy (EVT) is limited in patients with large-core acute ischemic stroke. MATERIALS AND METHODS: This was a subanalysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial, which assessed the efficacy of EVT in patients with large-vessel occlusion and extensive early ischemic changes. The primary outcome was a modified Rankin Scale (mRS) score of 0-3 at 90 days. Secondary outcomes included intracerebral hemorrhage (ICH) within 48 hours, symptomatic ICH, 90-day mortality, ordinal mRS shift, and ≥8-point improvement in National Institutes of Health Stroke Scale score at 48 hours. Logistic regression models were used to assess treatment effects and interactions between ATD and EVT. In the EVT cohort, prior ATD use was not associated with the primary outcome (adjusted OR 1.16, 95% CI 0.41-3.23). Results were consistent for antiplatelet drugs (adjusted OR 0.70, 95% CI 0.18-2.71) and anticoagulants (adjusted OR 1.52, 95% CI 0.45-5.20). CONCLUSIONS: In this exploratory subanalysis, prior ATD use did not significantly modify the observed treatment effect of EVT in patients with large-core acute ischemic stroke. These findings suggest that prior ATD use alone should not preclude consideration of EVT.