Meseguer Elena, Labreuche Julien, Guidoux Celine, Lavallée Philippa C, Cabrejo Lucie, Sirimarco Gaia, Valcarcel Jaime G, Klein Isabelle F, Amarenco Pierre, Mazighi Mikael
Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France; Laboratory of Vascular Translational Science, INSERM 1148 and Paris-Diderot University, Paris, France.
Int J Stroke. 2015 Feb;10(2):163-9. doi: 10.1111/ijs.12421. Epub 2014 Dec 8.
Thirty percent of ischemic stroke (IS) patients suffering from acute stroke are under antiplatelet therapy.
We evaluated whether prior antiplatelet use before intravenous (IV), intra-arterial (IA) or combined IV/IA therapy may be associated with worse outcomes and an increased intracerebral hemorrhage (ICH) risk after reperfusion therapies.
We analyzed data from our patient registry (n = 874) and conducted a systematic review of previous observational studies. The primary outcome was the percentage of patients who developed symptomatic ICH (sICH), defined in our registry per ECASS-II definition.
We identified 43 previous reports that evaluated the impact of prior antiplatelet use on outcomes after reperfusion therapy in AIS patients. Prior antiplatelet use was found in 35% of AIS patients, eligible for reperfusion therapies and was associated with a worse vascular profile. In an unadjusted meta-analysis that included our registry data, prior antiplatelet use was associated with more sICH per ECASS-II definition (OR, 1.78 (95% CI, 1.48-2.13), and less favorable outcome (OR, 0.86; 95% CI, 0.77-0.98). However, in multivariate analyses conducted in our registry showed that prior antiplatelet use was not associated with worse outcome (P > 0.23); and in the systematic review, only 3 studies reported a slight, but significant adjusted increase in sICH risk, of whom one had conflicting results according to sICH definition.
These results suggest no significant detrimental effect of prior antiplatelet use in AIS patients treated by IV, IA or combined IV/IA therapy. Further studies are needed to assess the specific impact of different and cumulative antiplatelet agents.
30%的急性缺血性卒中（IS）患者正在接受抗血小板治疗。
我们评估了在静脉内（IV）、动脉内（IA）或联合IV/IA治疗前使用抗血小板药物是否可能与更差的预后以及再灌注治疗后脑出血（ICH）风险增加相关。
我们分析了患者登记处的数据（n = 874），并对之前的观察性研究进行了系统评价。主要结局是发生症状性ICH（sICH）的患者百分比，在我们的登记处中根据ECASS-II定义进行定义。
我们确定了43篇之前的报告，这些报告评估了在急性缺血性卒中（AIS）患者中，治疗前使用抗血小板药物对再灌注治疗后结局的影响。在符合再灌注治疗条件的AIS患者中，35%的患者在治疗前使用了抗血小板药物，且与较差的血管状况相关。在一项纳入我们登记处数据的未调整荟萃分析中，根据ECASS-II定义，治疗前使用抗血小板药物与更多的sICH相关（比值比，1.78（95%置信区间，1.48 - 2.13）），且与较差的结局相关（比值比，0.86；95%置信区间，0.77 - 0.98）。然而，在我们登记处进行的多变量分析显示，治疗前使用抗血小板药物与较差的结局无关（P > 0.23）；在系统评价中，只有3项研究报告sICH风险有轻微但显著的调整后增加，其中一项根据sICH定义结果相互矛盾。
这些结果表明，在接受IV、IA或联合IV/IA治疗的AIS患者中，治疗前使用抗血小板药物没有显著的有害影响。需要进一步研究来评估不同和累积抗血小板药物的具体影响。
