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: | , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
February 7, 2025
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| 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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| 245 | 1 | 0 | |a Efficacy and safety of intravenous alteplase for unknown onset stroke on prior antiplatelet therapy |b post hoc analysis of the EOS individual participant data |c 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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| 520 | |a 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. | ||
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| 700 | 1 | |a Davis, Stephen M |e VerfasserIn |4 aut | |
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| 700 | 1 | |a Toyoda, Kazunori |e VerfasserIn |4 aut | |
| 700 | 1 | |a Thomalla, Götz |e VerfasserIn |4 aut | |
| 700 | 1 | |a Koga, Masatoshi |e VerfasserIn |4 aut | |
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