Journal article
The Use of Antiplatelet Agents and Heparin in the 24-Hour Postintravenous Alteplase Window for Neurointervention
Neurosurgery, v 88(4), pp 746-750
01 Apr 2021
PMID: 33442725
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Intravenous (IV) alteplase with mechanical thrombectomy has been found to be superior to alteplase alone in select patients with intracranial large vessel occlusion. Current guidelines discourage the use of antiplatelet agents or heparin for 24 h following alteplase. However, their use is often necessary in certain circumstances during thrombectomy procedures.
To study the safety and outcomes in patients who received blood thinning medications for thrombectomy after IV Tissue-Type plasminogen activator (tPA).
This is a multicenter retrospective review of the use of antiplatelet agents and/or heparin in patients within 24 h following tPA administration. Patient demographics, comorbidities, bleeding complications, and discharge outcomes were collected.
A series of 88 patients at 9 centers received antiplatelet medications and/or heparin anticoagulation following IV alteplase for revascularization procedures requiring stenting. The mean National Institutes of Health Stroke Scale (NIHSS) on admission was 14.6. Reasons for use of a stent included internal carotid artery occlusion in 74% of patients. Thrombolysis in cerebral infarction (TICI) 2b-3 revascularization was accomplished in 90% of patients. The rate of symptomatic intracranial hemorrhage (sICH) was 8%; this was not significantly different than the sICH rate for a matched group of patients not receiving antiplatelets or heparin during the same time frame. Functional independence at 90 d (modified Rankin Scale 0-2) was seen in 57.8% of patients. All-cause mortality was 12%.
The use of antiplatelet agents and heparin for stroke interventions following IV alteplase appears to be safe without significant increased risk of hemorrhagic complications in this group of patients when compared to control data and randomized controlled trials.
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Details
- Title
- The Use of Antiplatelet Agents and Heparin in the 24-Hour Postintravenous Alteplase Window for Neurointervention
- Creators
- Mandy J Binning - Neurosciences InstituteChristina R Maxwell - Neurosciences InstituteMichael McAree - Neurosciences InstituteErol Veznedaroglu - Neurosciences InstituteDaniel R Felbaum - MedStar Georgetown University HospitalAdam Arthur - Semmes Murphey FoundationNitin Goyal - Semmes Murphey FoundationStacey Q Wolfe - Central Baptist HospitalChristine Tschoe - Atrium Health Wake Forest BaptistR Webster Crowley - Rush UniversityElad Levy - University at Buffalo, State University of New YorkKunal Vakharia - University at Buffalo, State University of New YorkHamid H Rai - University at Buffalo Neurosurgery, Williamsville, New YorkAditya S Pandey - University of Michigan–Ann ArborBadih J Daou - University of Michigan–Ann ArborRabih G Tawk - Jacksonville CollegeAndrew J Ringer - Mayfield Brain & SpineKenneth M Liebman - Neurosciences InstituteEndovasc Neurosurg Res Grp ENRG
- Publication Details
- Neurosurgery, v 88(4), pp 746-750
- Publisher
- Oxford University Press
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology; Neurosurgery
- Web of Science ID
- WOS:000637320800035
- Scopus ID
- 2-s2.0-85102964055
- Other Identifier
- 991021918098604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery