• Georgios Tsivgoulis, Nitin Goyal, Ali Kerro, Aristeidis H Katsanos, Rashi Krishnan, Konark Malhotra, Abhi Pandhi, Peter Duden, Aman Deep, Reza Bavarsad Shahripour, Tomas Bryndziar, Katherine Nearing, Boris Chulpayev, Jason Chang, Ramin Zand, Anne W Alexandrov, and Andrei V Alexandrov.
• From the Department of Neurology (G.T., N.G., A.K., R.K., A.P., P.D., A.D., R.B.S., T.B., K.N., B.C., J.C., R.Z., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (K.M.), West Virginia University-Charleston Division; Department of Critical Care Medicine (J.C.), MedStar Washington Hospital Center, Washington, DC; and Department of Neurology (R.Z.), Geisinger Health System, Danville, PA.
• Neurology. 2018 Sep 11; 91 (11): e1067-e1076.

ObjectiveWe sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study.MethodsWe compared the following outcomes between DAPP+ and DAPP- IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0-1), and 3-month mortality.ResultsAmong 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP- patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47-8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06-5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP- patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes.ConclusionsDAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates.Classification Of EvidenceThis study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.© 2018 American Academy of Neurology.

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