When to Start Aspirin After Acute Stroke
When to Start Aspirin After Acute Stroke
Dear colleagues, I am Christoph Diener, a neurologist from Germany. My topic today is the treatment of acute stroke with thrombolysis. I think all of you know that systemic thrombolysis with recombinant tissue plasminogen activator (tPA) has a recanalization rate of about 50%-60%. Unfortunately, in about 20% of these patients, the vessel will reocclude after initial recanalization.
The question behind the study I will talk about today is whether intravenous aspirin can prevent reocclusion of the open vessel. Our colleagues in the Netherlands conducted a randomized trial. One half of the patients received tPA, and the other half received tPA in addition to 300 mg of aspirin intravenously. The study was performed between 2008 and 2011, and 642 patients with an acute stroke were randomized into the trial.
This trial was terminated prematurely because of futility and an increased risk for intracerebral bleeding. The primary endpoint was a good outcome; this was achieved in 174 patients in the combination treatment group (54%) compared with 183 patients (57%) in the monotherapy group. Unfortunately, there was a significant increase in symptomatic intracranial hemorrhages in the group receiving combination therapy with aspirin and tPA.
The conclusion of this study is that early initiation of antiplatelet therapy in combination with thrombolysis is dangerous. It is not effective, and I think we all should wait at least 24 hours to initiate antiplatelet therapy after tPA.
Ladies and gentlemen, I am Christoph Diener, a neurologist from Germany. Thank you very much for listening.
Dear colleagues, I am Christoph Diener, a neurologist from Germany. My topic today is the treatment of acute stroke with thrombolysis. I think all of you know that systemic thrombolysis with recombinant tissue plasminogen activator (tPA) has a recanalization rate of about 50%-60%. Unfortunately, in about 20% of these patients, the vessel will reocclude after initial recanalization.
The question behind the study I will talk about today is whether intravenous aspirin can prevent reocclusion of the open vessel. Our colleagues in the Netherlands conducted a randomized trial. One half of the patients received tPA, and the other half received tPA in addition to 300 mg of aspirin intravenously. The study was performed between 2008 and 2011, and 642 patients with an acute stroke were randomized into the trial.
This trial was terminated prematurely because of futility and an increased risk for intracerebral bleeding. The primary endpoint was a good outcome; this was achieved in 174 patients in the combination treatment group (54%) compared with 183 patients (57%) in the monotherapy group. Unfortunately, there was a significant increase in symptomatic intracranial hemorrhages in the group receiving combination therapy with aspirin and tPA.
The conclusion of this study is that early initiation of antiplatelet therapy in combination with thrombolysis is dangerous. It is not effective, and I think we all should wait at least 24 hours to initiate antiplatelet therapy after tPA.
Ladies and gentlemen, I am Christoph Diener, a neurologist from Germany. Thank you very much for listening.
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