Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator.

dc.contributor.author

Xian, Ying

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Federspiel, Jerome J

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Grau-Sepulveda, Maria

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Hernandez, Adrian F

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Schwamm, Lee H

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Bhatt, Deepak L

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Smith, Eric E

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Reeves, Mathew J

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Thomas, Laine

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Webb, Laura

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Bettger, Janet Prvu

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Laskowitz, Daniel T

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Fonarow, Gregg C

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Peterson, Eric D

dc.date.accessioned

2020-11-24T17:21:01Z

dc.date.available

2020-11-24T17:21:01Z

dc.date.issued

2016-01

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2020-11-24T17:21:00Z

dc.description.abstract

Intravenous tissue plasminogen activator (tPA) is known to improve outcomes in ischemic stroke; however, many patients may have been receiving antiplatelet therapy before acute ischemic stroke and could face an increased risk for bleeding when treated with tPA.To assess the risks and benefits associated with prestroke antiplatelet therapy among patients with ischemic stroke who receive intravenous tPA.This observational study used data from the American Heart Association and American Stroke Association Get With the Guidelines-Stroke registry, which included 85 072 adult patients with ischemic stroke who received intravenous tPA in 1545 registry hospitals from January 1, 2009, through March 31, 2015. Data were analyzed during the same period.Prestroke antiplatelet therapy before tPA administration for acute ischemic stroke.Symptomatic intracranial hemorrhage (sICH), in-hospital mortality, discharge ambulatory status, and modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]).Of the 85 072 registry patients, 38 844 (45.7%) were receiving antiplatelet therapy before admission; 46 228 patients (54.3%) were not. Patients receiving antiplatelet therapy were older (median [25th-75th percentile] age, 76 [65-84] vs 68 [56-80] years) and had a higher prevalence of cardiovascular risk factors. The unadjusted rate of sICH was higher in patients receiving antiplatelet therapy (5.0% vs 3.7%). After risk adjustment, prior use of antiplatelet agents remained associated with higher odds of sICH compared with no use (adjusted odds ratio [AOR], 1.18 [95% CI, 1.10-1.28]; absolute difference, +0.68% [95% CI, 0.36%-1.01%]; number needed to harm [NNH], 147). Among patients enrolled on October 1, 2012, or later, the highest odds (95% CIs) of sICH were found in 15 116 patients receiving aspirin alone (AOR, 1.19 [1.06- 1.34]; absolute difference [95% CI], +0.68% [0.21%-1.20%]; NNH, 147) and 2397 patients receiving dual antiplatelet treatment of aspirin and clopidogrel (AOR, 1.47 [1.16-1.86]; absolute difference, +1.67% [0.58%-3.00%]; NNH, 60). The risk for in-hospital mortality was similar between those who were and were not receiving antiplatelet therapy after adjustment (8.0% vs 6.6%; AOR, 1.00 [0.94-1.06]; nonsignificant absolute difference, -0.01% [-0.37% to 0.36%]). However, patients receiving antiplatelet therapy had a greater risk-adjusted likelihood of independent ambulation (42.1% vs 46.6%; AOR, 1.13 [1.08-1.17]; absolute difference, +2.23% [1.55%-2.92%]; number needed to treat, 43) and better functional outcomes (modified Rankin Scale score, 0-1) at discharge (24.1% vs 27.8%; AOR, 1.14; 1.07-1.22; absolute difference, +1.99% [0.78%-3.22%]; number needed to treat, 50).Among patients with an acute ischemic stroke treated with intravenous tPA, those receiving antiplatelet therapy before the stroke had a higher risk for sICH but better functional outcomes than those who were not receiving antiplatelet therapy.

dc.identifier

2467286

dc.identifier.issn

2168-6149

dc.identifier.issn

2168-6157

dc.identifier.uri

https://hdl.handle.net/10161/21716

dc.language

eng

dc.publisher

American Medical Association (AMA)

dc.relation.ispartof

JAMA neurology

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10.1001/jamaneurol.2015.3106

dc.subject

Humans

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Brain Ischemia

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Cerebral Hemorrhage

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Tissue Plasminogen Activator

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Platelet Aggregation Inhibitors

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Treatment Outcome

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Registries

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Risk Assessment

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Risk Factors

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Retrospective Studies

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Aged

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Aged, 80 and over

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Middle Aged

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Female

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Male

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Stroke

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Administration, Intravenous

dc.title

Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator.

dc.type

Journal article

duke.contributor.orcid

Xian, Ying|0000-0002-1237-1162

duke.contributor.orcid

Federspiel, Jerome J|0000-0003-0321-6280

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Hernandez, Adrian F|0000-0003-3387-9616

duke.contributor.orcid

Bettger, Janet Prvu|0000-0001-9708-8413

duke.contributor.orcid

Laskowitz, Daniel T|0000-0003-3430-8815

duke.contributor.orcid

Peterson, Eric D|0000-0002-5415-4721

pubs.begin-page

50

pubs.end-page

59

pubs.issue

1

pubs.organisational-group

School of Medicine

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Duke Clinical Research Institute

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Medicine, Cardiology

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Duke

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Institutes and Centers

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Medicine

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Clinical Science Departments

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Neurobiology

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Duke Science & Society

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Duke Innovation & Entrepreneurship

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Duke Global Health Institute

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Anesthesiology

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Neurosurgery

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Neurology, Neurocritical Care

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Basic Science Departments

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Initiatives

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Neurology

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Nursing

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Orthopaedics

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School of Nursing

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Staff

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Faculty

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Biostatistics & Bioinformatics

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Medicine, Clinical Pharmacology

pubs.publication-status

Published

pubs.volume

73

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