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Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial

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Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. / Frey, Benedikt M; Boutitie, Florent; Cheng, Bastian; Cho, Tae-Hee; Ebinger, Martin; Endres, Matthias; Fiebach, Jochen B; Fiehler, Jens; Ford, Ian; Galinovic, Ivana; Königsberg, Alina; Puig, Josep; Roy, Pascal; Wouters, Anke; Magnus, Tim; Thijs, Vincent; Lemmens, Robin; Muir, Keith W; Nighoghossian, Norbert; Pedraza, Salvador; Simonsen, Claus Z; Gerloff, Christian; Thomalla, Götz; WAKE-UP Investigators.

in: Neurol Res Pract, Jahrgang 2, 2020, S. 40.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Frey, BM, Boutitie, F, Cheng, B, Cho, T-H, Ebinger, M, Endres, M, Fiebach, JB, Fiehler, J, Ford, I, Galinovic, I, Königsberg, A, Puig, J, Roy, P, Wouters, A, Magnus, T, Thijs, V, Lemmens, R, Muir, KW, Nighoghossian, N, Pedraza, S, Simonsen, CZ, Gerloff, C, Thomalla, G & WAKE-UP Investigators 2020, 'Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial', Neurol Res Pract, Jg. 2, S. 40. https://doi.org/10.1186/s42466-020-00087-9

APA

Frey, B. M., Boutitie, F., Cheng, B., Cho, T-H., Ebinger, M., Endres, M., Fiebach, J. B., Fiehler, J., Ford, I., Galinovic, I., Königsberg, A., Puig, J., Roy, P., Wouters, A., Magnus, T., Thijs, V., Lemmens, R., Muir, K. W., Nighoghossian, N., ... WAKE-UP Investigators (2020). Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. Neurol Res Pract, 2, 40. https://doi.org/10.1186/s42466-020-00087-9

Vancouver

Frey BM, Boutitie F, Cheng B, Cho T-H, Ebinger M, Endres M et al. Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. Neurol Res Pract. 2020;2:40. https://doi.org/10.1186/s42466-020-00087-9

Bibtex

@article{591234f2fa2c435cad2fc1e6f58cd715,
title = "Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial",
abstract = "Background: One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial.Methods: WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0-1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase.Results: Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p <  0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047-4.236).Conclusions: Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.",
author = "Frey, {Benedikt M} and Florent Boutitie and Bastian Cheng and Tae-Hee Cho and Martin Ebinger and Matthias Endres and Fiebach, {Jochen B} and Jens Fiehler and Ian Ford and Ivana Galinovic and Alina K{\"o}nigsberg and Josep Puig and Pascal Roy and Anke Wouters and Tim Magnus and Vincent Thijs and Robin Lemmens and Muir, {Keith W} and Norbert Nighoghossian and Salvador Pedraza and Simonsen, {Claus Z} and Christian Gerloff and G{\"o}tz Thomalla and {WAKE-UP Investigators}",
note = "{\textcopyright} The Author(s) 2020.",
year = "2020",
doi = "10.1186/s42466-020-00087-9",
language = "English",
volume = "2",
pages = "40",
journal = "Neurol Res Pract",
issn = "2524-3489",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial

AU - Frey, Benedikt M

AU - Boutitie, Florent

AU - Cheng, Bastian

AU - Cho, Tae-Hee

AU - Ebinger, Martin

AU - Endres, Matthias

AU - Fiebach, Jochen B

AU - Fiehler, Jens

AU - Ford, Ian

AU - Galinovic, Ivana

AU - Königsberg, Alina

AU - Puig, Josep

AU - Roy, Pascal

AU - Wouters, Anke

AU - Magnus, Tim

AU - Thijs, Vincent

AU - Lemmens, Robin

AU - Muir, Keith W

AU - Nighoghossian, Norbert

AU - Pedraza, Salvador

AU - Simonsen, Claus Z

AU - Gerloff, Christian

AU - Thomalla, Götz

AU - WAKE-UP Investigators

N1 - © The Author(s) 2020.

PY - 2020

Y1 - 2020

N2 - Background: One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial.Methods: WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0-1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase.Results: Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p <  0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047-4.236).Conclusions: Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

AB - Background: One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial.Methods: WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0-1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase.Results: Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p <  0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047-4.236).Conclusions: Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

U2 - 10.1186/s42466-020-00087-9

DO - 10.1186/s42466-020-00087-9

M3 - SCORING: Journal article

C2 - 33324940

VL - 2

SP - 40

JO - Neurol Res Pract

JF - Neurol Res Pract

SN - 2524-3489

ER -