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Appropriate selection of patients with acute stroke for intravenous tissue plasminogen activator (t-PA) treatment is essential to maximize the probability of good outcome and to minimize treatment complications, particularly intracerebral hemorrhage. Guidelines specify withholding antiplatelet therapy for 24 hours after intravenous (IV) t-PA administration, but whether prior use of antiplatelet agents raises the risk for hemorrhage is uncertain.
In this study, the authors examined the risk for symptomatic intracerebral hemorrhage (SICH) in a prospective registry of 301 consecutive patients who received IV t-PA up to 4.5 hours after stroke onset. SICH occurred in significantly more of the patients with prior antiplatelet therapy (12 of 89, 13…