Aspirin Administration in Acute Ischemic Stroke Patients Treated With Alteplase

A three month treatment with 300 mg IV aspirin does not improve the functional outcome of alteplase-treated acute ischemic stroke patients. However, the risk of developing SICH and SAEs is enhanced.

Acute ischemic stroke occurs due to a block in the artery supplying to an area of the brain affected by stroke. Treatment of acute ischemic stroke involves breaking down of the clot with drugs like intravenous (IV) alteplase. However, 14-34% alteplase-treated patients experience re-occlusion – that is, the blood vessel gets blocked again with a clot – which is linked to clinical worsening of the patient’s condition. Previous studies in acute heart attack patients, suggest that prompt antiplatelet therapy post-alteplase treatment may reduce the risk of re-occlusion and improve outcome.

The current study published in the Lancet compared the treatment differences between alteplase therapy with or without 300mg intravenous aspirin.

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Acute ischemic stroke patients (642) were enrolled across 37 Netherlands centers. While 320 patients received alteplase treatment alone, 322 patients received 300mg IV aspirin within 90 min post-alteplase treatment. All patients were started on oral antiplatelet treatment 24 hours following treatment with alteplase. The primary endpoint was a positive outcome of treatment after 3 months. Symptomatic intracranial hemorrhage (SICH), that is bleeding within the skull and other serious adverse events (SAEs) were recorded as well.

Results show that after 3 months, a favorable outcome was observed in 174 (54%) and 183 (57·2%) patients from the aspirin group and alteplase-only treatment group, respectively. Mortality (11·2% vs. 9·7%), SICH (4.3% vs. 1.6%) and other SAEs occurred more frequently in the aspirin group than in the alteplase-only treatment group.

Thus, early administration of IV aspirin in alteplase-treated acute ischemic stroke patients does not improve the outcome after 3 months and increases the risk of serious complications. This treatment is therefore not currently recommended.

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Reference: Early administration of aspirin in patients treated with alteplase for acute ischemic stroke: a randomized controlled trial; Sanne Zinstok et al; The Lancet Online Publication 2012

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