MedicalResearch.com Interview with:
Ying Xian, PhD
Assistant Professor of Medicine.
Member in the Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Xian: Intravenous tissue plasminogen activator (tPA) is the only FDA approved medical therapy to reduce disability and improve outcomes for patients with acute ischemic stroke. But treatment with tPA also carries the risk of symptomatic intracranial hemorrhage (sICH), which is often fatal. Nearly half of ischemic stroke patients are taking antiplatelet drugs such as aspirin and/or clopidogrel prior to stroke. We found these patients had higher risk for sICH when treated with tPA. But the risk is relatively small. For every 147 patients on aspirin treated with tPA, only 1 more symptomatic intracranial hemorrhage as compared with those treated with tPA without prior antiplatelet therapy. The risk is slightly higher among those on dual antiplatelet therapy of aspirin and clopidogrel (number needed to harm 60). Despite the higher bleeding risk, patients treated with tPA on prior antiplatelet therapy appeared to have better functional outcomes in terms of ambulatory status and modified Rankin scale than those not on prior antiplatelet therapy. Therefore, overall the benefits of thrombolytic therapy may outweigh the risks.
Medical Research: What should clinicians and patients take away from your report?
Dr. Xian: Considering intravenous tPA is the only FDA approved medical therapy and remains substantially underused worldwide for patients with acute ischemic stroke, clinicians should consider intravenous tPA for eligible patients on prior antiplatelet therapy. I would like to quote from Dr. Mark Alberts, Vice Chair of Clinical Affairs in the Department of Neurology and Neurotherapeutics at UT Southwestern Medical Center, “the real risk is not treating.”
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Xian: As more potent P2Y12 inhibitors such as prasugrel and ticagrelor are increasingly used in the Unites States, future research is needed provide guidance on tPA for patients who developed ischemic stroke while taking these new antiplatelet drugs.
Ying Xian, PhD (2015). Benefits of tPS Outweigh Risks in Ischemia Stroke, Even in Patients on Antiplatelet Medications