Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment

Objective: To compare clinical outcomes of patients who received early initiation (<24 hours) of antithrombotics with those who received standard management (antithrombotics administered ≥24 hours).

Methods: A total of 712 patients who had an acute ischemic stroke and underwent IV or endovascular (intra-arterial [IA]) recanalization between July 2007 and March 2015 were selected from a prospective clinical registry. Antithrombotics were initiated by an individual clinical decision. We systemically gathered information regarding the exact timing of antithrombotic initiation from a database of the electronic barcode medication administration system.

Results: The recanalization treatment cases included in this study comprised 34% (n = 243) IV only, 32% (n = 229) IA only, and 34% (n = 240) combined IV-IA strategies. Antithrombotics were administered within 24 hours in 64% (n = 456) of the patients. Earlier initiation of antithrombotics was associated with decreased odds of having any hemorrhages (adjusted odds ratio 0.56; 95% confidence interval 0.35–0.89), but was not associated with symptomatic hemorrhages (0.85; 0.35–2.10) or modified Rankin Scale scores of 0–1 at 3 months after stroke (1.09; 0.75–1.59). Ultra-early initiation (<12 hours) did not increase the odds of hemorrhagic transformation (0.26; 0.12–0.52). The effects of earlier antithrombotics on the clinical outcomes were not significantly modified by the modality of recanalization treatment.

Conclusions: In our retrospective analysis of a prospective registry, early antithrombotic (within 24 hours after initiation) administration did not increase hemorrhages after recanalization treatment. Early antithrombotic therapy may be advantageous for a subset of stroke patients despite the current guidelines.