Early initiation of antiplatelet after mechanical thrombectomy improves outcomes, prevents recurrence in stroke patients

USA: Early initiation of antiplatelet (AP) medication after mechanical thrombectomy in patients with acute ischemic stroke (AIS) due to large vessel occlusions significantly increased odds of better postoperative functional outcomes without increasing hemorrhagic transformation risk, a recent study has found.

The researchers reported, "Administering antiplatelet medication within 24 hours of mechanical thrombectomy, an effective procedure for stroke may help patients more successfully recover and prevent high-risk individuals from experiencing additional strokes."

The study was presented at the Society of NeuroInterventional Surgery’s (SNIS) 20th Annual Meeting on August 1, 2023.

The antiplatelet medication prevents blood clots from forming (and potentially causing strokes) by keeping platelets from sticking together. However, this medication can also potentially cause brain bleeding if administered soon after a mechanical thrombectomy. To find a way to safely use this essential medication without causing additional risk to patients, researchers reviewed data from 190 patients who underwent this treatment between 2016–2020 and categorized patients by those who received antiplatelet medication less than 24 hours after surgery and those who received the medication later.

In their study, “Safety and Functional Outcomes with Early Initiation of Antiplatelet Therapy Following Mechanical Thrombectomy in Emergent Large Vessel Occlusion Strokes: A Single Institution Registry Study,” researchers noted that patients who received antiplatelet medication within 24 hours of mechanical thrombectomy were significantly more physically independent at discharge from the hospital than patients who received the antiplatelet medication later. This difference was maintained longer-term as well, with patients who received early antiplatelet medication having much better physical functioning scores one month and three months after surgery. In addition, there was no sign that giving patients antiplatelet medication earlier led to increased risk of brain bleeding after surgery.

“Continuously working to improve patient outcomes is one of our top priorities,” said Dr. Hepzibha Alexander, a neurosurgery resident at Ascension Providence Hospital in Southfield, Michigan, and lead author in the study. “Finding a new way to safely use this already-essential medication is an exciting step forward in helping patients thrive after stroke.”