Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Practice Point
  • Published:

Thrombolysis for acute stroke under antiplatelet therapy: safe enough to be beneficial?

Nature Clinical Practice Neurology volume 4, pages 474–475 (2008)Cite this article

Abstract

Controversy exists over whether chronic antiplatelet therapy in patients with acute ischemic stroke is a contraindication to treatment with tissue plasminogen activator (tPA). Antiplatelets impair thrombocyte function and might, therefore, increase the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis. This Practice Point commentary discusses a recent study by Uyttenboogaart et al. that aimed to further explore the interactions between antiplatelet and tPA therapies. The single-center study, which included 301 consecutive patients with ischemic stroke, found that the incidence of SICH was indeed increased among patients who were pretreated with antiplatelets, but that these patients nevertheless had a greater net benefit of thrombolysis than did those who had not received previous antiplatelet therapy. The commentary authors consider the study's shortcomings, but conclude that the widespread practice of using tPA in the presence of antiplatelet therapy is justified.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Uyttenboogaart M et al. (2008) Safety of antiplatelet therapy prior to intravenous thrombolysis in acute ischemic stroke. Arch Neurol 65: 607–611

    Article  Google Scholar 

  2. Wahlgren N et al. (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369: 275–282

    Article  CAS  Google Scholar 

  3. Hacke W et al. (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363: 768–774

    Article  Google Scholar 

  4. The European Stroke Organisation (ESO) writing committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25: 457–507

  5. Adams HP et al. (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 38: 1655–1711

    Article  Google Scholar 

  6. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581–1587

  7. Sanossian N et al. (2006) Premorbid antiplatelet use and ischemic stroke outcomes. Neurology 66: 319–323

    Article  CAS  Google Scholar 

  8. Wolf PA et al. (1991) Probability of stroke: a risk profile from the Framingham Study. Stroke 22: 312–318

    Article  CAS  Google Scholar 

  9. Schmulling S et al. (2003) Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke. Cerebrovasc Dis 16: 183–190

    Article  Google Scholar 

  10. Tanne D et al. (2002) Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 105: 1679–1685

    Article  CAS  Google Scholar 

  11. The NINDS t-PA Stroke Study Group (1997) Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 28: 2109–2118

  12. Larrue V et al. (2001) Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 32: 438–441

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. in the Department of Neurology, W Hacke is Professor and Chair, and C Lichy is a Senior Neurologist, University of Heidelberg, Heidelberg, Germany.,

    Werner Hacke & Christoph Lichy

Authors
  1. Werner Hacke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Lichy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner Hacke.

Ethics declarations

Competing interests

Werner Hacke is a consultant for, and has received speaker's honoraria from, Boehringer Ingelheim. Christoph Lichy declared no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hacke, W., Lichy, C. Thrombolysis for acute stroke under antiplatelet therapy: safe enough to be beneficial?. Nat Rev Neurol 4, 474–475 (2008). https://doi.org/10.1038/ncpneuro0867

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0867

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing