Early deterioration after thrombolysis plus aspirin in acute stroke: a post hoc analysis of the Antiplatelet Therapy in Combination with Recombinant t-PA Thrombolysis in Ischemic Stroke trial.
BACKGROUND AND PURPOSE
Aspirin early after intravenous thrombolysis in acute ischemic stroke increases the risk of symptomatic intracranial hemorrhage (SICH), without influencing functional outcome at 3 months. The effect of aspirin on early neurological deterioration (END) was explored as a post hoc analysis of the randomized Antiplatelet Therapy in Combination With Recombinant t-PA Thrombolysis in Ischemic Stroke (ARTIS) trial.


METHODS
END, defined as a ≥4 points National Institutes of Health Stroke Scale worsening ≤24 hours after intravenous thrombolysis, was categorized into SICH (ENDSICH) and cerebral ischemia (ENDCI). Multinomial logistic regression was used to assess the effect of aspirin on END.


RESULTS
Of the 640 patients, 31 patients (4.8%) experienced END (14 ENDSICH, 17 ENDCI). Aspirin increased the risk of ENDSICH (odds ratio, 3.73; 95% confidence interval, 1.03-13.49) but not of ENDCI (odds ratio, 1.14; 95% confidence interval, 0.44-3.00). After adjustment for other explanatory variables, the association between aspirin and ENDSICH remained significant.


CONCLUSIONS
In this trial, there is no evidence of an early antithrombotic effect from the addition of aspirin to intravenous thrombolysis in acute ischemic stroke.
['Zinkstok|Sanne M|SM|', 'Beenen|Ludo F|LF|', 'Majoie|Charles B|CB|', 'Marquering|Henk A|HA|', 'de Haan|Rob J|RJ|', 'Roos|Yvo B|YB|']
D000368:Aged D001241:Aspirin D005260:Female D005343:Fibrinolytic Agents D006801:Humans D020300:Intracranial Hemorrhages D008297:Male D008875:Middle Aged D010975:Platelet Aggregation Inhibitors D020521:Stroke D015912:Thrombolytic Therapy D010959:Tissue Plasminogen Activator
aspirin stroke safety thrombolytic therapy