Prior antiplatelet therapy does not raise tPA hemorrhage risk

4 July 2008

MedWire News: Patients who were taking aspirin at stroke onset should not be excluded from thrombolytic therapy, say researchers.

Yolanda Bravo Anguiano (Hospital General Yagüe, Burgos, Spain) and team found that patients undergoing stroke thrombolysis had a slight increase in symptomatic bleeding risk if they had been taking aspirin, but that this was not significant.

The findings agree with those of another study recently reported by MedWire News, which found that patients had better overall thrombolysis outcomes if they had previous aspirin, despite a slightly increased risk for bleeding.

Anguiano and colleagues studied 605 patients treated with intravenous tissue plasminogen activator (tPA), 22% of whom were taking antiplatelets at onset. Most of these patients had been using aspirin.

Intracranial hemorrhage did not vary with previous antiplatelet use, occurring in 18.4% of patients taking antiplatelets and 20.2% of those who were not.

Patients taking antiplatelets had a slight increase in the risk for parenchymal hemorrhage type 2 and for symptomatic intracranial hemorrhage compared with the control group, at 5.9% versus 3.4% and 6.6% versus 3.6%, respectively. But these differences were not significant.

Antiplatelet therapy did not predict symptomatic hemorrhage even after multivariate analysis. Only activated partial thromboplastin time was independently associated with symptomatic hemorrhage risk.

"Our data suggest that pre-treatment with antiplatelets should not be a contraindication for intravenous thrombolysis," conclude the researchers in the journal Cerebrovascular Diseases.

Cerebrovasc Dis 2008; Advance online publication