Safety and efficacy of dual antiplatelet pretreatment in ischemic stroke patients treated with IV thrombolysis: A systematic review and meta-analysis.
In this paper, the authors report safety and efficacy of iv alteplase in ischemic stroke patients who were on dual antiplatelets. Antiplatelet pre-treatment is not an exclusion criterion for the use of iv alteplase; however, some concern persists particularly because of conflicting data and recent suggestions from ENCHANTED trial that prior antiplatelets use is associated with increased symptomatic intracerebral haemorrhage risk. This is therefore an important study which tackles an important clinically relevant question. Also, this is a robust meta analysis of almost 70 000 patients. In unadjusted analyses, they noted increased risk of symptomatic intracerebral haemorrhages amongst patients on dual anti platelets who received iv alteplase for acute ischemic stroke; this, however, was not associated with poor functional outcomes. In a adjusted analysis however, prior treatment with dual anti platelets was not associated with increased risk of symptomatic intracerebral haemorrhages. This meta analysis adds to our evidence in favour of the use of iv alteplase in ischemic stroke patients who are on dual anti platelets.
Malhotra K, Katsanos AH, Goyal N, Ahmed N, Strbian D, Palaiodimou L, Karapanayiotides T, Alexandrov AW, Grotta JC, Alexandrov AV, Tsivgoulis G. Safety and efficacy of dual antiplatelet pretreatment in ischemic stroke patients treated with IV thrombolysis: A systematic review and meta-analysis. Neurology. 2020 Jan 20. pii: 10.1212/WNL.0000000000008961. doi: 10.1212/WNL.0000000000008961.