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Background <p>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.</p> Methods <p>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.</p> Results <p>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]; <i>P</i> &lt; 0.01), any ICH (OR, 1.44; 95%CI [1.16, 1.78]; <i>P</i> &lt; 0.01), mortality (OR, 1.39; 95%CI [1.23, 1.58]; <i>P</i> &lt; 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).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月22日

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  • Ahmed Naeem,
  • Hesham Kelani,
  • Hazem Mohamed Salamah,
  • Rowan H. Elhalag,
  • Hossam Tharwat Ali,
  • Ayham Mohammad Hussein,
  • Omar Abdelnasser,
  • Mostafa Mahmoud Naguib,
  • Salem Elshenawy,
  • Abdelrhman M. Abdelwahab,
  • Nadia Albaramony,
  • Omar El Sayed Rageh,
  • Abdallah R. Allam,
  • Aliaa Bakr,
  • Mohamed Abuelazm,
  • Ahmed Madkoor,
  • Travis R. Quinoa,
  • Arthur D. Kay,
  • David P. Lerner,
  • Lisa R. Merlin,
  • Eytan Raz,
  • Alejandro M. Spiotta,
  • Stephan A. Mayer

摘要

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.