Safety and efficacy of dual antiplatelet pretreatment in ischemic stroke patients treated with IV thrombolysis: A systematic review and meta-analysis

Objective Conflicting data exist on the safety and efficacy of IV thrombolysis (IVT) in patients with acute ischemic stroke (AIS) receiving dual antiplatelet pretreatment (DAPP). The aim of the present systematic review and meta-analysis is to assess the safety and outcome of DAPP history among patients with AIS treated with IVT. Methods We performed a comprehensive literature review to identify studies that investigated the safety and efficacy of DAPP among patients with AIS treated with IVT. Results We identified 9 studies comprising 66,675 patients. In unadjusted analyses, DAPP was associated with a higher likelihood of pooled symptomatic intracranial hemorrhage (sICH; odds ratio [OR] 2.26; 95% confidence interval [CI] 1.39–3.67) and 3-month mortality (OR 1.47; 95% CI 1.25–1.73). DAPP was also related to higher odds of sICH according to Safe Implementation of Treatments in Stroke Monitoring Study (OR 2.71; 95% CI 2.05–3.59), European Cooperative Acute Stroke Study II (OR 2.23; 95% CI 1.46–3.40), and National Institute of Neurological Disorders and Stroke (OR 1.59, 95% CI 1.38–1.83) definitions. There was no association between DAPP and 3-month favorable functional outcome (FFO, modified Rankin Scale [mRS] score 0–1) and 3-month functional independence (FI; mRS score 0–2). In adjusted analyses, history of DAPP was not associated with pooled sICH (OR 2.03; 95% CI 0.75–5.52), 3-month mortality (OR 1.11; 95% CI 0.87–1.40), 3-month FFO (OR 0.92; 95% CI 0.77–1.09), and 3-month FI (OR 1.01; 95% CI 0.89–1.15). Conclusions After adjustment for potential confounders, DAPP appears not to be associated with higher risk of adverse outcomes in patients with AIS treated with IVT.