Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy

Xiaochuan Huo; Raynald Raynald; Jing Jing; Anxin Wang; Dapeng Mo; Feng Gao; Ning Ma; Yilong Wang; Yongjun Wang; Zhongrong Miao

doi:10.1136/svn-2020-000466

Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy

Stroke Vasc Neurol. 2020 Nov 11;6(2):230-237. doi: 10.1136/svn-2020-000466. Online ahead of print.

Authors

Xiaochuan Huo^#¹, Raynald Raynald^#¹, Jing Jing^{2

3

4}, Anxin Wang^{2

3

4}, Dapeng Mo⁵, Feng Gao⁵, Ning Ma⁵, Yilong Wang^{2

3

4}, Yongjun Wang^{2

3

4}, Zhongrong Miao⁶

Affiliations

¹ Neurointervention center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁴ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁵ Beijing Tiantan Hospital, Beijing, China.
⁶ Neurointervention center, Beijing Tiantan Hospital, Beijing, China doctorzhongrongm@126.com.

^# Contributed equally.

Abstract

Background and purpose: To investigate the safety and efficacy of oral antiplatelet therapy (APT) for patients who had acute ischaemic stroke (AIS), receiving endovascular therapy (EVT).

Methods: Patients were divided into non-APT group and APT (single APT or dual APT (DAPT)) group. The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage (sICH), recanalisation rate, clinical outcome and mortality.

Results: Among 915 patients who had AIS, those in APT group (n=199) showed shorter puncture-to-recanalisation time, lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group (n=716) (p<0.05 for all). Oral APT was found to be associated with superior clinical outcome compared with non-APT (APT (44.2%) versus non-APT (41.1%)), adjusted OR=2.605, 95% CI 1.244 to 5.455, p=0.011). DAPT showed superior clinical outcome compared with non-APT (DAPT (56.5%) versus non-APT (41.1%), adjusted OR=5.405, 95% CI 1.614 to 18.102, p=0.006) and lower risk of mortality at 3-month follow-up (DAPT (4.8%) versus non-DAPT (17.7%), adjusted OR=0.008, 95% CI 0.000 to 0.441, p=0.019). There was no significant difference in sICH between the two groups.

Conclusions: Oral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes. DAPT may associate with superior clinical outcomes and lower risk of mortality.

Keywords: stroke.