Safety of early antiplatelet administration in patients with acute ischemic stroke treated with alteplase (SEAPT-24)

J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106868. doi: 10.1016/j.jstrokecerebrovasdis.2022.106868. Epub 2022 Nov 5.


Objectives: Alteplase, a tissue-type plasminogen activator, is recommended for ischemic stroke patients presenting within 4.5 h. Due to bleeding risks, current guidelines advise delaying antiplatelet therapy for 24 h after alteplase. However, specific scenarios may require antiplatelet therapy to be given within the 24 h window. This study aimed to examine the safety of early antiplatelet therapy administration within the first 24 h after alteplase.

Materials and methods: This study is a retrospective, observational study of adult patients with acute ischemic stroke who received alteplase across a multi-hospital system. Patients were grouped based on early antiplatelet therapy (within 24 h window) or as recommended per guidelines. The occurrence of bleeding events, including symptomatic intracranial hemorrhage and/or gastrointestinal bleeding, in-hospital mortality, unfavorable outcomes (modified Rankin score 3-6), and hospital length of stay, were compared between groups.

Results: Patients were predominantly African American (72%) and female (53%) with a median age of 62 years. Median baseline NIHSS scores were higher in the early group (5 vs. 7; p = 0.04), and patients in the early group were more likely to undergo endovascular therapy (26% vs. 8%, p < 0.0001). In patients treated with alteplase only and who did not undergo endovascular therapy, there was no difference in symptomatic intracranial hemorrhage (1.4% vs. 0%, p = 0.1), gastrointestinal bleeding, in-hospital mortality, unfavorable outcomes, or length of stay.

Conclusions: In our retrospective analysis, early administration of antiplatelet therapy (< 24 h post-alteplase) did not increase the risk of symptomatic intracranial hemorrhage, gastrointestinal bleeding, or unfavorable outcomes in patients who received alteplase alone for management of acute ischemic stroke. Prospective studies are needed to validate these findings.

Keywords: alteplase; antiplatelet; aspirin; early administration.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Brain Ischemia* / chemically induced
  • Brain Ischemia* / diagnosis
  • Brain Ischemia* / drug therapy
  • Female
  • Fibrinolytic Agents
  • Gastrointestinal Hemorrhage / chemically induced
  • Humans
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Hemorrhages / drug therapy
  • Ischemic Stroke*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / adverse effects
  • Retrospective Studies
  • Stroke* / diagnosis
  • Stroke* / drug therapy
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome


  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Tissue Plasminogen Activator