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Open Access 29-10-2024 | Alteplase | Review Article

Early antiplatelet therapy after intravenous thrombolysis for acute ischemic stroke: a systematic review and meta-analysis

Authors: Hesham Kelani, Ahmed Naeem, Rowan H. Elhalag, Mohamed Abuelazm, Nadia Albaramony, Ahmed Abdelazeem, Mohammad El-Ghanem, Travis R. Quinoa, Diana Greene-Chandos, Ketevan Berekashvili, Ambooj Tiwari, Arthur D. Kay, David P. Lerner, Lisa R. Merlin, Fawaz Al-Mufti

Published in: Neurological Sciences

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Abstract

Background

Early neurological deterioration (END) and recurrence of vessel blockage frequently complicate intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Several studies have indicated the potential effectiveness of the early initiation (within < 24 h) of antiplatelet therapy (APT) after IVT. However, conflicting results have been reported by other studies. We aimed to offer a thorough overview of the current literature through a systematic review and meta-analysis.

Methods

Our systematic review and meta-analysis were prospectively registered on PROSPERO (ID: CRD42023488173) following the PRISMA guidelines. We systematically searched Web of Science, SCOPUS, PubMed, and Cochrane Library until May 5, 2024. Rayyan. ai facilitated the screening process. The R statistical programming language was used to calculate the odds ratios and conduct a meta-analysis. Our primary outcomes were excellent functional recovery (modified Rankin Scale score 0–1), symptomatic intracranial hemorrhage (sICH), and mortality.

Results

Eight studies involving 2,134 participants were included in the meta-analysis. Early APT showed statistically significant increased odds of excellent functional recovery (mRS 0–1) compared to the standard APT group (OR, 1.81; [95% CI: 1.10, 2.98], p = 0.02). However, we found no differences between the early and standard APT groups regarding sICH (OR, 1.74; [95% CI: 0.91, 3.33], p = 0.10) and mortality (OR, 0.88; [95% CI: 0.62, 1.24]; p = 0.47).

Conclusion

Early APT within 24 h of IVT in stroke patients is safe, with no increase in bleeding risk, and has a positive effect on excellent functional recovery. However, there was a statistically insignificant trend of increased sICH with early APT, and the current evidence is based on highly heterogeneous studies. Further large-scale RCTs are warranted.
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Metadata
Title
Early antiplatelet therapy after intravenous thrombolysis for acute ischemic stroke: a systematic review and meta-analysis
Authors
Hesham Kelani
Ahmed Naeem
Rowan H. Elhalag
Mohamed Abuelazm
Nadia Albaramony
Ahmed Abdelazeem
Mohammad El-Ghanem
Travis R. Quinoa
Diana Greene-Chandos
Ketevan Berekashvili
Ambooj Tiwari
Arthur D. Kay
David P. Lerner
Lisa R. Merlin
Fawaz Al-Mufti
Publication date
29-10-2024
Publisher
Springer International Publishing
Published in
Neurological Sciences
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-024-07821-0

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