• Mandy J Binning, Christina R Maxwell, Michael McAree, Erol Veznedaroglu, Daniel R Felbaum, Adam Arthur, Nitin Goyal, Stacey Q Wolfe, Christine Tschoe, R Webster Crowley, Elad Levy, Kunal Vakharia, Hamid H Rai, Aditya S Pandey, Badih J Daou, Rabih G Tawk, Andrew J Ringer, and Kenneth M Liebman.
• Global Neurosciences Institute, Lawrenceville, New Jersey.
• Neurosurgery. 2021 Mar 15; 88 (4): 746-750.

BackgroundIntravenous (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.ObjectiveTo study the safety and outcomes in patients who received blood thinning medications for thrombectomy after IV Tissue-Type plasminogen activator (tPA).MethodsThis 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.ResultsA 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%.ConclusionThe 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.© Congress of Neurological Surgeons 2021.

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