학술논문
Abstract P7: Prior Antithrombotic Medication May Affect Outcomes Following Alteplase at 0.6mg for Unknown Onset Stroke: THAWS Randomized Clinical Trial
Document Type
Article
Author
Koga, Masatoshi; Inoue, Manabu; Miwa, Kaori; Yoshimura, Sohei; Fukuda-doi, Mayumi; Aoki, Junya; Asakura, Koko; Ohtaki, Masafumi; Kamiyama, Kenji; Igarashi, Shuichi; Doijiri, Ryosuke; Ito, Yasuhiro; Takagi, Yasushi; Ihara, Masafumi; Sasaki, Makoto; Kitazono, Takanari; Kimura, Kazumi; Minematsu, Kazuo; Yamamoto, Haruko; Toyoda, Kazunori
Source
Stroke (Ovid); March 2021, Vol. 52 Issue: Supplement 1 pAP7-AP7, 1p
Subject
Language
ISSN
00392499; 15244628
Abstract
Background and purpose:To assess the potential effect of prior antithrombotic medication for thrombolysis using alteplase at 0.6mg/kg in unknown onset stroke.Methods:This was a prespecified sub-analysis of a THAWS trial (an investigator-initiated, multicenter, randomized, open, blinded-endpoint trial). Stroke patients with a time last-known-well >4.5 h who had a mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery were randomly assigned (1:1) to receive alteplase at 0.6mg/kg or standard medical treatment (SMT). Patients were dichotomized by taking prior antithrombotic medication. The favorable outcome defined as a modified Rankin Scale score of 0-1 at 90 days and any intracranial hemorrhage within 22-36 h were compared in each group.Results:Of 126 patients (intention-to-treat population), 68 received alteplase and 58 had SMT. Seventeen in the alteplase group and 23 in the SMT group took antithrombotic medication (10 with antiplatelet alone, 5 with anticoagulant alone and 2 with both in the IVT group, and 14, 8 and 1, respectively, in the SMT group) before stroke onset. Antithrombotic therapy was more frequently initiated within 24 hours after randomization in the SMT group than in the alteplase group (86% vs. 12%, p<0.0001). Both any intracranial hemorrhage (26% in the alteplase group vs. 14% in the SMT group) and favorable outcome (47% vs. 48%) were comparable between the two treatment groups. There was a significant treatment-by-cohort interaction for favorable outcome between patients with prior antithrombotic medication and those without (p=0.006). Favorable outcome was more common in the alteplase group than in the SMT group in patients with prior antithrombotic medication (59% vs. 26%; RR 2.25, 95% CI 1.02 to 4.99), but it tended to be less common in the alteplase group than in the SMT group in those without prior antithrombotic medication (43% vs. 63%; RR 0.69, 95% CI 0.46 to 1.03). The frequency of any intracranial hemorrhage did not differ significantly between the two treatment groups in any dichotomized patients.Conclusions:Alteplase at 0.6mg/kg appears more beneficial in patients with prior antithrombotic medication.