Timing matters: early antiplatelet therapy optimizes alteplase treatment in acute ischemic stroke.
The optimal timing for initiating antiplatelet therapy (APT) after intravenous alteplase in acute ischemic stroke (AIS) remains unclear, due to concerns about intracranial hemorrhage. This study evaluated the safety and efficacy of early APT (≤24 h post-alteplase) versus standard APT (>24 h) in AIS patients.
We conducted a retrospective analysis of 154 AIS patients treated with intravenous alteplase between May 2019 and December 2022. Patients were stratified into early APT (E-APT, n = 77) and standard APT (S-APT, n = 77) groups. Neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge and at 3 months. Coagulation parameters and hemorrhagic events were monitored to evaluate safety.
Baseline characteristics were comparable between groups. At 3 months, the E-APT group demonstrated significantly greater neurological improvement (ΔNIHSS: 4.31 ± 3.45 vs. 3.25 ± 3.49; p = 0.041) and better functional outcomes (mRS: 0.98 ± 1.12 vs. 1.35 ± 1.24; p = 0.030) than the S-APT group. Early APT was not associated with increased cerebral hemorrhage (0% vs. 2.6%, p = 0.155) or mortality (2.6% vs. 5.2%, p = 0.405). Spearman correlation confirmed that shorter intervals from alteplase to APT were associated with improved outcomes (ΔNIHSS: ρ = -0.28, p = 0.001; mRS: ρ = 0.24, p = 0.003). Subgroup analyses indicated that aspirin was the primary contributor to the observed benefits.
Initiating APT within 24 h after alteplase improves neurological and functional recovery in AIS without increasing hemorrhagic risk. These findings suggest that earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations.
We conducted a retrospective analysis of 154 AIS patients treated with intravenous alteplase between May 2019 and December 2022. Patients were stratified into early APT (E-APT, n = 77) and standard APT (S-APT, n = 77) groups. Neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge and at 3 months. Coagulation parameters and hemorrhagic events were monitored to evaluate safety.
Baseline characteristics were comparable between groups. At 3 months, the E-APT group demonstrated significantly greater neurological improvement (ΔNIHSS: 4.31 ± 3.45 vs. 3.25 ± 3.49; p = 0.041) and better functional outcomes (mRS: 0.98 ± 1.12 vs. 1.35 ± 1.24; p = 0.030) than the S-APT group. Early APT was not associated with increased cerebral hemorrhage (0% vs. 2.6%, p = 0.155) or mortality (2.6% vs. 5.2%, p = 0.405). Spearman correlation confirmed that shorter intervals from alteplase to APT were associated with improved outcomes (ΔNIHSS: ρ = -0.28, p = 0.001; mRS: ρ = 0.24, p = 0.003). Subgroup analyses indicated that aspirin was the primary contributor to the observed benefits.
Initiating APT within 24 h after alteplase improves neurological and functional recovery in AIS without increasing hemorrhagic risk. These findings suggest that earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations.