RT Journal Article
SR Electronic
T1 Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 279
OP 288
DO 10.1136/svn-2022-002267
VO 9
IS 3
A1 Ingleton, Adam
A1 Raseta, Marko
A1 Chung, Rui-En
A1 Kow, Kevin Jun Hui
A1 Weddell, Jake
A1 Nayak, Sanjeev
A1 Jadun, Changez
A1 Hashim, Zafar
A1 Qayyum, Noman
A1 Ferdinand, Phillip
A1 Natarajan, Indira
A1 Roffe, Christine
YR 2024
UL http://svn.bmj.com/content/9/3/279.abstract
AB Background Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We evaluated outcomes and complications of patients stented with and without intravenous aspirin during MT.Methods All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital, UK between 2010 and 2020, were included. Patients were thrombolysed before MT, unless contraindicated. Aspirin 500 mg intravenously was given intraoperatively at the discretion of the operator. Symptomatic intracranial haemorrhage (sICH) and the National Institutes for Health Stroke Scale score (NIHSS) were recorded at 7 days, and mortality and functional recovery (modified Rankin Scale: mRS ≤2) at 90 days.Results Out of 565 patients treated by MT 102 patients (median age 67 IQR 57–72 years, baseline median NIHSS 18 IQR 13–23, 76 (75%) thrombolysed) had a stent placed. Of these 49 (48%) were given aspirin and 53 (52%) were not. Patients treated with aspirin had greater NIHSS improvement (median 8 IQR 1–16 vs median 3 IQR −9–8 points, p=0.003), but there were no significant differences in sICH (2/49 (4%) vs 9/53 (17%)), mRS ≤2 (25/49 (51%) vs 19/53 (36%)) and mortality (10/49 (20%) vs 12/53 (23%)) with and without aspirin. NIHSS improvement (median 12 IQR 4–18 vs median 7 IQR −7–10, p=0.01) was greater, and mortality was lower (4/33 (12%) vs 6/15 (40%), p=0.05) when aspirin was combined with thrombolysis, than for aspirin alone, with no increase in bleeding.Conclusion Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes, even when combined with intravenous thrombolysis.Data are available upon reasonable request. The datasets generated and analysed during the current study are not publicly available, but anonymised data may be available from the corresponding author on reasonable request.