Early administration of aspirin plus alteplase does not improve outcome in stroke patients

Early administration of intravenous aspirin, in addition to alteplase, does not improve functional outcome at 3 months for patients with acute ischemic stroke, but increases the risk of symptomatic intracranial hemorrhage (SICH), according to a study published online August 25 in The Lancet.

Sanne M Zinkstok, MD, of the Department of Neurology at the Academic Medical Center at the University of Amsterdam in Amsterdam, Netherlands, and colleagues, compared the effects of early addition of 300 mg intravenous aspirin to alteplase with standard alteplase without aspirin.

Between July 29, 2008, and April 20, 2011, the authors randomized 642 patients with acute ischemic stroke treated with alteplase to receive either 300 mg of intravenous aspirin within 90 minutes after starting alteplase treatment, or no additional treatment. Both groups received oral antiplatelet therapy 24 hours after beginning alteplase treatment. The trial was terminated early because of an excess of SICH and no evidence of benefit in the aspirin group.

At 3 months, 54% of patients in the aspirin group versus 57.2% of patients in the standard treatment group had a favorable outcome. SICH occurred more often in the aspirin group than the standard treatment group (4.3% of patients versus 1.6% of patients) and was more often the cause of poor outcome in the aspirin group compared with the standard treatment group.

Although the authors note that the increased risk of SICH in the patients treated with early aspirin should be interpreted with caution due to the relatively small number of patients and a very low SICH rate in the standard treatment group, they conclude that "the results of our trial do not support a change of the current guidelines, which advise starting antiplatelet therapy 24 hours after alteplase."