Department of Medicine (Neurology), University of Alberta, 8440 112th Avenue, Edmonton, AB, Canada.
Cerebrovasc Dis. 2010;30(5):508-13. doi: 10.1159/000319029. Epub 2010 Sep 22.
Our goal is to assess if current antiplatelet (AP) use has an effect on recanalization rate and outcome in acute stroke patients.
We conducted a retrospective analysis of acute stroke patients who received intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and had transcranial Doppler examination within 3 h of symptom onset. The TCD findings were interpreted using the Thrombolysis in Brain Ischemia flow grading system as persistent arterial occlusion, reocclusion or complete recanalization. Complete recanalization was defined as established Thrombolysis in Brain Ischemia 4 or 5 within 2 h of IV rt-PA. The patients were divided based on their current use of AP agents. Comparisons were made between the different groups based on recanalziation rate, reocclusion and good long-term outcome (mRS ≤ 2) using χ(2) test. Multiple regression analysis was used to identify AP use as a predictor for recanalization and outcome including symptomatic intracranial hemorrhage after controlling for age, baseline NIHSS score, time to treatment, previous vascular event, hypertension and diabetes mellitus.
Two hundred and eighty-four patients were included; 154 (54%) males, 130 (46%) females, with a mean age of 69.5 ± 13 years. The median baseline NIHSS score was 16 ± 5. The median time to TCD examination was 131 ± 38 min from symptom onset. The median time to IV rt-PA was 140 ± 34 min. One hundred eighty patients were not on AP prior to their stroke, 76 were on aspirin, 15 were on clopidogrel, 2 were on aspirin-dipyridamole combination, 2 were on both aspirin and clopidogrel, and 9 patients on subtherapeutic coumadin. In patients who were naïve to AP, 68/178 (38.2%) had complete recanalization, whereas in the AP group, 25/91 (28%) had complete recanalization. Patients on aspirin alone had a lower recanalization rate (16/72) as compared to those not on AP (22 vs. 39%) (p = 0.017), while those on clopidogrel had higher rates of complete recanalization (9/19, 60%). There was no difference in the rate of symptomatic intracranial hemorrhages in patients on AP agents as compared to those not on AP (9/180, 5% vs. 9/95, 9.5%) (p = 0.13). A good long-term outcome (mRS ≤2) was achieved in 85/160 (53%) of the patients naïve to AP and in 33/84 (39%) of the patients on AP (p = 0.035). In multiple regression, AP use was not a predictor of either recanalization rate (p = 0.057) or good outcome (p = 0.27).
No correlation was found between AP use and recanalization rate and good outcome in patients with acute stroke who received IV rt-PA treatment. Prior AP use should not defer patients from receiving IV rt-PA treatment in an acute stroke setting.
评估急性脑卒中患者目前抗血小板（AP）治疗对再通率和预后的影响。
我们对接受静脉（IV）重组组织型纤溶酶原激活剂（rt-PA）治疗且在症状发作后 3 小时内接受经颅多普勒检查的急性脑卒中患者进行了回顾性分析。TCD 发现采用溶栓治疗脑缺血血流分级系统进行解释，分为持续性动脉闭塞、再闭塞或完全再通。完全再通定义为静脉 rt-PA 后 2 小时内达到溶栓治疗脑缺血 4 或 5 级。根据当前使用 AP 药物将患者分为两组。根据再通率、再闭塞和良好的长期预后（mRS≤2），使用 χ(2)检验比较不同组之间的差异。采用多元回归分析，在控制年龄、基线 NIHSS 评分、治疗时间、既往血管事件、高血压和糖尿病后，确定 AP 使用是否为再通和预后的预测因素，包括症状性颅内出血。
共纳入 284 例患者；154 例（54%）为男性，130 例（46%）为女性，平均年龄为 69.5±13 岁。中位数基线 NIHSS 评分为 16±5。中位数 TCD 检查时间为症状发作后 131±38 分钟。中位数静脉 rt-PA 时间为 140±34 分钟。180 例患者在卒中前未使用 AP，76 例使用阿司匹林，15 例使用氯吡格雷，2 例使用阿司匹林-双嘧达莫联合治疗，2 例同时使用阿司匹林和氯吡格雷，9 例使用亚治疗剂量的华法林。在未使用 AP 的患者中，68/178（38.2%）完全再通，而在 AP 组中，25/91（28%）完全再通。单独使用阿司匹林的患者（16/72）再通率低于未使用 AP 的患者（22%比 39%）（p=0.017），而使用氯吡格雷的患者完全再通率较高（9/19，60%）。AP 组与未使用 AP 组的症状性颅内出血发生率无差异（9/180，5%比 9/95，9.5%）（p=0.13）。在未使用 AP 的患者中，85/160（53%）获得了良好的长期预后（mRS≤2），而在使用 AP 的患者中，33/84（39%）获得了良好的长期预后（p=0.035）。多元回归分析显示，AP 使用不是再通率（p=0.057）或良好预后（p=0.27）的预测因素。
急性脑卒中患者接受 IV rt-PA 治疗后，AP 使用与再通率和良好预后之间未发现相关性。AP 使用不应延迟急性脑卒中患者接受 IV rt-PA 治疗。
