Kelani Hesham, Naeem Ahmed, Elhalag Rowan H, Abuelazm Mohamed, Albaramony Nadia, Abdelazeem Ahmed, El-Ghanem Mohammad, Quinoa Travis R, Greene-Chandos Diana, Berekashvili Ketevan, Tiwari Ambooj, Kay Arthur D, Lerner David P, Merlin Lisa R, Al-Mufti Fawaz
Neurology Department, SUNY DOWNSTATE Health Science University, One Brooklyn Health, Brooklyn, NY, USA.
Al-Azhar Faculty of Medicine, Asyut, Egypt.
Neurol Sci. 2025 Feb;46(2):617-631. doi: 10.1007/s10072-024-07821-0. Epub 2024 Oct 29.
Early neurological deterioration (END) and recurrence of vessel blockage frequently complicate intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Several studies have indicated the potential effectiveness of the early initiation (within < 24 h) of antiplatelet therapy (APT) after IVT. However, conflicting results have been reported by other studies. We aimed to offer a thorough overview of the current literature through a systematic review and meta-analysis.
Our systematic review and meta-analysis were prospectively registered on PROSPERO (ID: CRD42023488173) following the PRISMA guidelines. We systematically searched Web of Science, SCOPUS, PubMed, and Cochrane Library until May 5, 2024. Rayyan. ai facilitated the screening process. The R statistical programming language was used to calculate the odds ratios and conduct a meta-analysis. Our primary outcomes were excellent functional recovery (modified Rankin Scale score 0-1), symptomatic intracranial hemorrhage (sICH), and mortality.
Eight studies involving 2,134 participants were included in the meta-analysis. Early APT showed statistically significant increased odds of excellent functional recovery (mRS 0-1) compared to the standard APT group (OR, 1.81; [95% CI: 1.10, 2.98], p = 0.02). However, we found no differences between the early and standard APT groups regarding sICH (OR, 1.74; [95% CI: 0.91, 3.33], p = 0.10) and mortality (OR, 0.88; [95% CI: 0.62, 1.24]; p = 0.47).
Early APT within 24 h of IVT in stroke patients is safe, with no increase in bleeding risk, and has a positive effect on excellent functional recovery. However, there was a statistically insignificant trend of increased sICH with early APT, and the current evidence is based on highly heterogeneous studies. Further large-scale RCTs are warranted.
早期神经功能恶化（END）和血管阻塞复发常使急性缺血性卒中（AIS）的静脉溶栓（IVT）复杂化。多项研究表明，IVT后早期（<24小时内）启动抗血小板治疗（APT）具有潜在疗效。然而，其他研究报告的结果相互矛盾。我们旨在通过系统评价和荟萃分析全面概述当前文献。
我们的系统评价和荟萃分析按照PRISMA指南在PROSPERO（ID：CRD42023488173）上进行了前瞻性注册。我们系统检索了Web of Science、SCOPUS、PubMed和Cochrane图书馆，直至2024年5月5日。Rayyan.ai协助筛选过程。使用R统计编程语言计算比值比并进行荟萃分析。我们的主要结局是良好的功能恢复（改良Rankin量表评分0-1）、症状性颅内出血（sICH）和死亡率。
荟萃分析纳入了8项研究，共2134名参与者。与标准APT组相比，早期APT显示良好功能恢复（mRS 0-1）的比值比有统计学显著增加（OR，1.81；[95%CI：1.10，2.98]，p = 0.02）。然而，我们发现早期和标准APT组在sICH（OR，1.74；[95%CI：0.91，3.33]，p = 0.10）和死亡率（OR，0.88；[95%CI：0.62，1.24]；p = 0.47）方面没有差异。
卒中患者IVT后24小时内早期APT是安全的，出血风险没有增加，并且对良好的功能恢复有积极作用。然而，早期APT有sICH增加的趋势，但无统计学意义，且目前的证据基于高度异质性的研究。有必要进行进一步的大规模随机对照试验。
