Prestroke Dual Antiplatelet Therapy and Symptomatic Intracerebral Hemorrhage After Thrombolytic Therapy

Intravenous tissue plasminogen activator (IV tPA) improves outcomes for patients with acute ischemic stroke but carries a risk for intracerebral hemorrhage (ICH). Antiplatelet therapy is typically held for the first 24 hours to mitigate this early risk, but whether prestroke antiplatelet therapy, the effects of which can last for days, also increases the risk for symptomatic hemorrhage after IV tPA is unclear. Moreover, dual antiplatelet therapy in particular is associated with increased hemorrhagic risk on its own. To examine the associated risks, investigators identified 321,819 patients in the Get With the Guidelines–Stroke registry who were treated with IV tPA from 2013 through 2021.

The rate of symptomatic intracranial hemorrhage (sICH)…