Effect of antiplatelet pretreatment on safety and efficacy outcomes in acute ischemic stroke patients after intravenous thrombolysis: a systematic review and meta-analysis

ABSTRACT

Background: About 40% of acute ischemic stroke patients are under antiplatelet pretreatment. Previous studies have shown conflicting results on the effect of prior antiplatelet agents on post thrombolytic clinical outcomes.

Methods: A systematic search using PubMed and EMBASE databases for eligible studies. Prior antiplatelet safety was measured by symptomatic intracerebral hemorrhage (sICH) and mortality. Efficacy was measured by functional independence and favorable functional outcome.

Results: Crude analysis indicated that antiplatelet pretreatment was associated with sICH and mortality. In adjusted analysis, the results confirmed a nonsignificant association between antiplatelet pretreatment and a higher risk of sICH and mortality, but demonstrated that antiplatelet pretreatment tended to improve functional independence and favorable functional outcome. Subgroup analysis detected a racial disparity in prior antiplatelet effect on sICH and the association between antiplatelet pretreatment and sICH was dependent on different antiplatelet regiments.

Conclusion: There was no significant difference in sICH and mortality between patients with and without antiplatelet pretreatment. Besides, antiplatelet pretreatment did not adversely affect the efficacy outcomes. The prevalence of sICH among Asians receiving antiplatelet pretreatment was relatively high. Additionally, it needs to be noticed that the effect of preexisting antiplatelet on clinical outcomes may be dependent on post thrombolytic antiplatelet regiments.

KEYWORDS:

• Acute ischemic stroke
• antiplatelet pretreatment
• intravenous thrombolysis
• meta-analysis

Article highlights

• Previous studies have shown conflicting results on the effect of prior antiplatelet agents on clinical outcomes following thrombolysis for AIS.

• Preadmission antiplatelet therapy had a higher likelihood to increase the risk of postthrombolytic sICH has been reported in the previous meta-analysis.

• Our study showed that previous antiplatelet treatment did not adversely affect sICH risk, morality rate, and functional outcomes.

• There may be a racial disparity in the antiplatelet effect on the risk of sICH.

• Subgroup analysis detected the highest risk of developing sICH in aspirin and clopidogrel dual therapy group.

• When it comes to efficacy outcomes, patients who under prior aspirin monotherapy seemed to benefit the most.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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Additional information

Funding

This study was supported by grants from National Natural Science Foundation of China (81673511), Jiangsu Science and Technology Development Plan (BE2017613), Jiangsu Six Talent Peaks Project (WSN-151), Nanjing Medical Science and Technique Development Foundation (QRX17020; ZKX15027; ZKX14038).