Safety of Antiplatelet Therapy in Noncardioembolic Ischemic Stroke With Thrombocytopenia: The CASE II Study

Author:

Xu Dongjuan1,Zhou Huan2,Zhang Tingxia2,Gong Weiwei3,Zhong Jieming3,Yu Han4,Chen Fujian5,Zhong Wansi2,Yan Shenqiang2ORCID,Lou Min2ORCID,

Affiliation:

1. Department of Neurology Dongyang Affiliated Hospital of Wenzhou Medical University Dongyang China

2. Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China

3. Zhejiang Provincial Center for Disease Control and Prevention Hangzhou China

4. Department of Neurology Yongjia people’s Hospital Yongjia China

5. Department of Neurology People’s Hospital of Anji Anji China

Abstract

Background There is scant evidence regarding the safety of antiplatelet therapy in acute ischemic stroke (AIS) patients with thrombocytopenia. Our study aims to address this concern by examining AIS patients with thrombocytopenia from a large database in real‐world settings. Methods and Results We included patients with AIS with a platelet count <100×10 9 /L who had complete records of antiplatelet drug use. Those requiring anticoagulation or having contraindications to antiplatelet therapy were excluded. Short‐term safety outcomes were in‐hospital bleeding events, while the long‐term safety outcome was 1‐year all‐cause mortality. A good clinical outcome was defined as functional independence, indicated by a modified Rankin Scale score of 0 to 2 at discharge. Propensity score matched analyses were used. We screened 169 423 patients with AIS from 90 stroke centers in the CASE II register, ultimately enrolling 2808 noncardioembolic patients with thrombocytopenia. In the propensity score matched analyses, no significant difference was observed between the antiplatelet and nonantiplatelet groups in terms of intracranial hemorrhage (odds ratio=0.855 [95% CI, 0.284–5.478]; P =0.160) or gastrointestinal bleeding (odds ratio=2.034 [95% CI, 0.755–5.478]; P =0.160). Antiplatelet therapy was associated with improved functional outcomes at discharge (odds ratio=1.405 [95% CI, 1.028–1.920]; P =0.033), and showed a trend towards reducing 1‐year mortality (odds ratio=0.395 [95% CI, 0.152–1.031]; P =0.058). Conclusions The use of antiplatelet therapy lessened as platelet count decreased in patients with AIS with thrombocytopenia. However, our findings suggest that antiplatelet medications remain safe and effective for this population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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