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Original research
Stroke outcome of early antiplatelet in post-thrombolysis haemorrhagic infarction
  1. Wansi Zhong1,
  2. Shenqiang Yan1,
  3. Zhicai Chen1,
  4. Zhongyu Luo1,
  5. Yi Chen1,
  6. Xuting Zhang1,
  7. Chenglong Wu2,
  8. Weiguo Tang3,
  9. Xiaoling Zhang4,
  10. Yaxian Wang5,
  11. Qun Gu6,
  12. Dongjuan Xu7,
  13. Hongfang Chen8,
  14. Min Lou1
  15. on behalf of the CASE-II Study Group
  1. 1 Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
  2. 2 Neurology, Shaoxing People's Hospital, Shaoxing, China
  3. 3 Neurology, Zhoushan Hospital, Zhoushan, China
  4. 4 Neurology, Jiaxing Second Hospital, Jiaxing, China
  5. 5 Neurology, Huzhou Central Hospital, Huzhou, China
  6. 6 Neurology, Huzhou First People's Hospital, Huzhou, China
  7. 7 Neurology, Dongyang People’s Hospital, Jinhua, China
  8. 8 Neurology, Jinhua Central Hospital, Jinhua, China
  1. Correspondence to Dr Min Lou, Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China; lm99{at}zju.edu.cn

Abstract

Background and purpose Initiation of early antiplatelet (EA) therapy after acute ischaemic stroke (AIS) is essential. We aimed to investigate the safety and effectiveness of EA therapy in patients who had an AIS with haemorrhagic infarction (HI) after intravenous thrombolysis (IVT).

Methods Based on a multicentre stroke registry database, patients who had an AIS with post-thrombolysis HI at 24 hours were identified. EA users and non-EA users were defined as patients with HI who received or did not receive antiplatelet therapy between 24 and 48 hours after IVT. Primary outcome was favourable outcome defined as modified Rankin Scale scores 0–2 at 3 months. Secondary outcomes were early neurological deterioration (END) and haemorrhagic transformation expansion.

Results A total of 842 patients with HI were identified from 24 061 thrombolytic patients within 4.5 hours, and 341 (40.5%) received EA therapy. EA users were more likely to have a favourable outcome (55.7% vs 39.5%, OR 1.565; 95% CI 1.122 to 2.182; p=0.008) and lower rate of END (12.6% vs 21.4%, OR 0.585; 95% CI 0.391 to 0.875; p=0.009) compared with non-EA users. EA therapy was not associated with haemorrhagic transformation expansion (p=0.125). After propensity score matching, EA therapy was still independently associated with favourable outcome (54.3% vs 46.3%, OR 1.495; 95% CI 1.031 to 2.167; p=0.038) and lower risk of END (13.5% vs 21.2%, OR 0.544; 95% CI 0.350 to 0.845; p=0.007).

Conclusions Antiplatelet therapy can be safely used between 24 and 48 hours when HI occurs after IVT, and such therapy is associated with reduced risk of END and improved neurological outcome in patients who had an AIS.

  • STROKE
  • CLINICAL NEUROLOGY

Data availability statement

Data are available upon reasonable request. The raw data supporting the conclusions of this article will be made available by the authors on reasonable request, without undue reservation.

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Data availability statement

Data are available upon reasonable request. The raw data supporting the conclusions of this article will be made available by the authors on reasonable request, without undue reservation.

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Footnotes

  • WZ and SY contributed equally.

  • Contributors ML acts as guarator and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. ML, WZ and SY had the idea for the study. WZ, SY and ZC initiated the study. ML, WZ, ZC, SY, YC, XZ, CW, WT, XZ, YW, QG, DX and HC participated in data collection. WZ, SY and ZL prepared and analysed the data. WZ drafted the manuscript, and ML and SY revised it. All authors commented on the draft and approved the final manuscript.

  • Funding This study was supported by the National Natural Science Foundation of China (81971101, 82171276), and the Science Technology Department of Zhejiang Province (2018C04011).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.