Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial - Archive ouverte HAL Access content directly
Journal Articles Neurological Research and Practice Year : 2020

Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial

Benedikt Frey
Florent Boutitie
  • Function : Author
Bastian Cheng
  • Function : Author
Tae-Hee Cho
  • Function : Author
Martin Ebinger
  • Function : Author
Matthias Endres
  • Function : Author
Jochen Fiebach
  • Function : Author
Jens Fiehler
  • Function : Author
Ian Ford
  • Function : Author
Ivana Galinovic
  • Function : Author
Alina Königsberg
  • Function : Author
Josep Puig
  • Function : Author
Anke Wouters
  • Function : Author
Tim Magnus
  • Function : Author
Vincent Thijs
  • Function : Author
Robin Lemmens
  • Function : Author
Keith Muir
  • Function : Author
Norbert Nighoghossian
  • Function : Author
Salvador Pedraza
  • Function : Author
Claus Simonsen
  • Function : Author
Christian Gerloff
  • Function : Author
Götz Thomalla
  • Function : Author

Abstract

Abstract Background One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial. Methods WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0–1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase. Results Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p < 0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome ( p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047–4.236). Conclusions Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

Dates and versions

hal-04152410 , version 1 (05-07-2023)

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Benedikt Frey, Florent Boutitie, Bastian Cheng, Tae-Hee Cho, Martin Ebinger, et al.. Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. Neurological Research and Practice, 2020, 2 (1), pp.40. ⟨10.1186/s42466-020-00087-9⟩. ⟨hal-04152410⟩

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