Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission.
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105677 http://hdl.handle.net/11449/207382 |
Resumo: | Background: Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. Methods: This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes. Results: Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3–7) vs. 2 (1–4), p = 0.044] and had higher mRS at discharge (mRS 2 [1–5] vs. mRS 1 [0–2], p = 0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (p = 0.254). Conclusion: DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding. |
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Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission.BleedingDual antiplatelet therapyIntracranial HemorrhagesStrokeBackground: Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. Methods: This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes. Results: Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3–7) vs. 2 (1–4), p = 0.044] and had higher mRS at discharge (mRS 2 [1–5] vs. mRS 1 [0–2], p = 0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (p = 0.254). Conclusion: DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding.Neurology Division Hospital de Clínicas Universidade Federal do ParanáStatistics Center Hospital de Clínicas Universidade Federal do ParanáNeurology Division Medical School UNESPHospital Sírio LibanesNeurology Division Medical School UNESPUniversidade Federal do Paraná (UFPR)Universidade Estadual Paulista (Unesp)Hospital Sírio LibanesScavasine, Valeria CristinaBarbosa, Rubens MendesLopes Neto, Francisco Diego NegraoGermininani, Francisco Manoel BrancoBazan, Rodrigo [UNESP]Zétola, Viviane FlumignanMassaro, Ayrton RobertoLange, Marcos Christiano2021-06-25T10:54:15Z2021-06-25T10:54:15Z2021-05-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105677Journal of Stroke and Cerebrovascular Diseases, v. 30, n. 5, 2021.1532-85111052-3057http://hdl.handle.net/11449/20738210.1016/j.jstrokecerebrovasdis.2021.1056772-s2.0-85101878929Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of Stroke and Cerebrovascular Diseasesinfo:eu-repo/semantics/openAccess2021-10-23T16:58:19Zoai:repositorio.unesp.br:11449/207382Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462021-10-23T16:58:19Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
title |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
spellingShingle |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. Scavasine, Valeria Cristina Bleeding Dual antiplatelet therapy Intracranial Hemorrhages Stroke |
title_short |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
title_full |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
title_fullStr |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
title_full_unstemmed |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
title_sort |
Risk of Early Bleeding with Dual Antiplatelet Therapy in Acute Stroke and Transient Ischemic Attack Regardless of NIHSS Admission. |
author |
Scavasine, Valeria Cristina |
author_facet |
Scavasine, Valeria Cristina Barbosa, Rubens Mendes Lopes Neto, Francisco Diego Negrao Germininani, Francisco Manoel Branco Bazan, Rodrigo [UNESP] Zétola, Viviane Flumignan Massaro, Ayrton Roberto Lange, Marcos Christiano |
author_role |
author |
author2 |
Barbosa, Rubens Mendes Lopes Neto, Francisco Diego Negrao Germininani, Francisco Manoel Branco Bazan, Rodrigo [UNESP] Zétola, Viviane Flumignan Massaro, Ayrton Roberto Lange, Marcos Christiano |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Federal do Paraná (UFPR) Universidade Estadual Paulista (Unesp) Hospital Sírio Libanes |
dc.contributor.author.fl_str_mv |
Scavasine, Valeria Cristina Barbosa, Rubens Mendes Lopes Neto, Francisco Diego Negrao Germininani, Francisco Manoel Branco Bazan, Rodrigo [UNESP] Zétola, Viviane Flumignan Massaro, Ayrton Roberto Lange, Marcos Christiano |
dc.subject.por.fl_str_mv |
Bleeding Dual antiplatelet therapy Intracranial Hemorrhages Stroke |
topic |
Bleeding Dual antiplatelet therapy Intracranial Hemorrhages Stroke |
description |
Background: Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. Methods: This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes. Results: Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3–7) vs. 2 (1–4), p = 0.044] and had higher mRS at discharge (mRS 2 [1–5] vs. mRS 1 [0–2], p = 0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (p = 0.254). Conclusion: DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-25T10:54:15Z 2021-06-25T10:54:15Z 2021-05-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105677 Journal of Stroke and Cerebrovascular Diseases, v. 30, n. 5, 2021. 1532-8511 1052-3057 http://hdl.handle.net/11449/207382 10.1016/j.jstrokecerebrovasdis.2021.105677 2-s2.0-85101878929 |
url |
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105677 http://hdl.handle.net/11449/207382 |
identifier_str_mv |
Journal of Stroke and Cerebrovascular Diseases, v. 30, n. 5, 2021. 1532-8511 1052-3057 10.1016/j.jstrokecerebrovasdis.2021.105677 2-s2.0-85101878929 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Journal of Stroke and Cerebrovascular Diseases |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1799964734312677376 |