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Efficacy and safety of intravenous alteplase for unknown onset stroke on prior antiplatelet therapy: post hoc analysis of the EOS individual participant data

Background: The effects of intravenous alteplase in patients with prior antiplatelet therapy (APT) remain controversial. We aimed to assess the efficacy and safety of imaging-based intravenous alteplase in patients with unknown onset stroke with prior APT. - Methods: Data from randomized controlled...

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Main Authors: Shiomi, Yuma (Author) , Miwa, Kaori (Author) , Jensen, Märit (Author) , Inoue, Manabu (Author) , Yoshimura, Sohei (Author) , Kamogawa, Naruhiko (Author) , Fukuda-Doi, Mayumi (Author) , Ma, Henry (Author) , Ringleb, Peter A. (Author) , Wu, Ona (Author) , Schwamm, Lee H (Author) , Davis, Stephen M (Author) , Donnan, Geoffrey A (Author) , Gerloff, Christian (Author) , Nakahara, Jin (Author) , Toyoda, Kazunori (Author) , Thomalla, Götz (Author) , Koga, Masatoshi (Author)
Format: Article (Journal)
Language:English
Published: February 7, 2025
In: International journal of stroke
Year: 2025, Volume: 20, Issue: 6, Pages: 679-686
ISSN:1747-4949
DOI:10.1177/17474930251322034
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1177/17474930251322034
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Author Notes:Yuma Shiomi, Kaori Miwa, Märit Jensen, Manabu Inoue, Sohei Yoshimura, Naruhiko Kamogawa, Mayumi Fukuda-Doi, Henry Ma, Peter Ringleb, Ona Wu, Lee H Schwamm, Stephen M Davis, Geoffrey A Donnan, Christian Gerloff, Jin Nakahara, Kazunori Toyoda, Götz Thomalla and Masatoshi Koga, on behalf of Evaluation of Unknown Onset Stroke Thrombolysis trials (EOS) Investigators
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Summary:Background: The effects of intravenous alteplase in patients with prior antiplatelet therapy (APT) remain controversial. We aimed to assess the efficacy and safety of imaging-based intravenous alteplase in patients with unknown onset stroke with prior APT. - Methods: Data from randomized controlled trials comparing alteplase with placebo/standard care in patients with unknown onset acute ischemic stroke from the Evaluation of Unknown Onset Stroke Thrombolysis (EOS) individual patient data meta-analysis collaboration were analyzed. Favorable outcome was defined as a modified Rankin Scale score of 0-1 at 90 days post-stroke. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22-36 h and 90-day mortality. - Results: Overall, 780 patients had available baseline data on prior APT. Compared with the no prior APT group (n = 523), the prior APT group (n = 257) was older (72 vs. 66 years) and had a higher prevalence of vascular risk factors. There was no interaction between prior APT and treatment effects of alteplase (p for interaction = 0.23). In the prior APT patients, 55/125 (45%) patients in the alteplase group and 39/132 (30%) patients in the control group had a favorable outcome (adjusted odds ratio [aOR], 2.07 [95% confidence interval, 1.18-3.64]). The rates of sICH and mortality in the alteplase and control groups were 5.6% and 0.8% (aOR, 7.78 [0.94-63.37]) and 6.5% and 6.1% (aOR, 1.12 [0.38-3.36]), respectively. In the no prior APT patients, 136 patients (50%) in the alteplase group and 112 patients (45%) in the control group had a favorable outcome (aOR, 1.39 [0.94-2.05]). Safety outcomes were not significantly different between the groups (sICH: 3 [1.1%] vs. 1 [0.4%]; mortality: 13 [4.9%] vs. 3 [1.2%]). - Conclusions: Alteplase has consistent efficacy regardless of prior APT in patients with unknown onset stroke. In addition, prior APT does not significantly increase the risk of sICH or mortality.
Item Description:Gesehen am 01.08.2025
Physical Description:Online Resource
ISSN:1747-4949
DOI:10.1177/17474930251322034

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