Impact of prior antiplatelet therapy on safety and efficacy of alteplase in acute ischemic stroke: a systematic review and meta-analysis.

• Tác giả: Omar Abdelnasser, Abdelrhman M Abdelwahab, Mohamed Abuelazm, Nadia Albaramony, Hossam Tharwat Ali, Abdallah R Allam, Aliaa Bakr, Rowan H Elhalag, Salem Elshenawy, Ayham Mohammad Hussein, Arthur D Kay, Hesham Kelani, David P Lerner, Ahmed Madkoor, Stephan A Mayer, Lisa R Merlin, Ahmed Naeem, Mostafa Mahmoud Naguib, Travis R Quinoa, Omar El Sayed Rageh, Eytan Raz, Hazem Mohamed Salamah, Alejandro M Spiotta
• Ngôn ngữ: eng
• Ký hiệu phân loại: 152.1 Sensory perception
• Thông tin xuất bản: Italy : Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology , 2025
• Bộ sưu tập: NCBI
• ID: 550471

Tóm tắt

 BACKGROUND: Intravenous thrombolysis (IVT), utilizing the clot-dissolving medications alteplase (rt-PA) or tenecteplase (TNK), is the cornerstone in acute ischemic stroke (AIS) emergency intervention. However, the impact of prior antiplatelet therapy (APT) on post-IVT outcomes when utilizing alteplase remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of prior APT on the outcomes after using alteplase in AIS patients. METHODS: We conducted a systematic review and meta-analysis synthesizing studies, which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through June 30, 2024. We used the R language V. 4.3. to pool dichotomous data using odds ratio (OR) with a 95% confidence interval (CI). PROSPERO ID: CRD42024495393. RESULTS: Thirty studies were included in our analysis, with 436,232 patients. Prior APT was significantly associated with increased odds of symptomatic intracranial hemorrhage (sICH) (OR, 1.78
  95%CI [1.48, 2.13]
  P <
  0.01), any ICH (OR, 1.44
  95%CI [1.16, 1.78]
  P <
  0.01), mortality (OR, 1.39
  95%CI [1.23, 1.58]
  P <
  0.01), and poor functional outcomes (modified Rankin Scale score of 3-6 [mRS 3-6]) (OR, 1.81
  95%CI [1.03, 3.19]
  P = 0.04). Additionally, prior APT significantly reduced the odds of good functional outcome [mRS 0-2] (OR, 0.85
  95%CI [0.74, 0.97]
  P = 0.02). CONCLUSION: Prior APT increased hemorrhagic complications, mortality, and poor functional outcome, while reducing the odds of good functional outcome after IV alteplase. Future research should focus on identifying adjunctive agents that may decrease hemorrhagic complications and investigate the impact of various APT regimens and alternative thrombolytics beyond alteplase in this specific population.