Hémorragie intracrânienne et pronostic fonctionnel post-AVC chez les patients traités par thrombolyse et thrombectomie : influence des antiagrégants plaquettaires

Abstract : Background and Purpose: several randomized trials showed better functional outcomes after intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) but there is some uncertainty about the influence of prior antiplatelet (AP) agent use on outcomes in this population. We aimed to determinate whether prior AP use may be associated with an increased risk of symptomatic intracranial hemorrhage (SICH) and influenced functional outcome in patient with AIS treated with a combined reperfusion therapy. Methods: we analyzed our prospectively compiled database of AIS patients who underwent MT with IVT pre-treatment between January 2015 and May 2017. Main outcomes were patients’ functional status at 90 days and the incidence of SICH. Outcomes were compared according to the presence of prior AP use and associations were investigated using a multivariable logistic regression analysis. Results: we included 207 patients. Prior AP was documented in 74 patients (35,7%). Patients with prior AP had significantly higher rates of SICH (27% vs 4%; p<0,001) and of functional dependence (modified Rankin Scale >2) at 90 days (70% vs 37%; p<0,001). Prior AP was independently associated with increased likelihood of SICH (OR 5,79; 95%CI [2,86; 12,24]; p<0,001) and of functional dependence at 90 days (OR 4,06; 95%CI [1,63;10,64]; p<0,005), on multivariable analysis. Conclusions: prior AP use in AIS patients treated with IVT and MT significantly and independently increased the risk of SICH and of functional dependence at 90 days. Further studies are warranted to confirm these results.
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Master Thesis
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Marie Couture. Hémorragie intracrânienne et pronostic fonctionnel post-AVC chez les patients traités par thrombolyse et thrombectomie : influence des antiagrégants plaquettaires. Médecine humaine et pathologie. 2018. ⟨dumas-02073294⟩

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