Timing matters: early antiplatelet therapy optimizes alteplase treatment in acute ischemic stroke.

Early antiplatelet therapy (≤24 h post-alteplase) resulted in significantly greater neurological improvement at 3 months compared to standard timing (>24 h).

• ΔNIHSS at 3 months: 4.31 ± 3.45 in the E-APT group vs. 3.25 ± 3.49 in the S-APT group (p = 0.041)
• Study included 154 AIS patients treated with intravenous alteplase between May 2019 and December 2022
• Patients were stratified into early APT (E-APT, n = 77) and standard APT (S-APT, n = 77) groups
• Baseline characteristics were comparable between groups

Early antiplatelet therapy was associated with significantly better functional outcomes at 3 months as measured by the modified Rankin Scale.

• mRS at 3 months: 0.98 ± 1.12 in the E-APT group vs. 1.35 ± 1.24 in the S-APT group (p = 0.030)
• Lower mRS scores indicate less disability
• Functional outcomes were assessed at both discharge and 3 months post-stroke

Early antiplatelet therapy was not associated with increased rates of cerebral hemorrhage or mortality.

• Cerebral hemorrhage rate: 0% in E-APT vs. 2.6% in S-APT (p = 0.155)
• Mortality rate: 2.6% in E-APT vs. 5.2% in S-APT (p = 0.405)
• Coagulation parameters and hemorrhagic events were monitored to evaluate safety
• Neither hemorrhage nor mortality differences reached statistical significance

Shorter intervals from alteplase administration to antiplatelet therapy initiation were correlated with improved neurological and functional outcomes.

• Spearman correlation between interval to APT and ΔNIHSS: ρ = -0.28, p = 0.001
• Spearman correlation between interval to APT and mRS: ρ = 0.24, p = 0.003
• A negative correlation with ΔNIHSS indicates shorter intervals correspond to greater neurological improvement
• A positive correlation with mRS indicates shorter intervals correspond to lower (better) disability scores

Subgroup analyses identified aspirin as the primary contributor to the observed clinical benefits of early antiplatelet therapy.

• Subgroup analyses were conducted to evaluate specific antiplatelet agents
• Aspirin was identified as the primary driver of the neurological and functional benefits observed in the E-APT group
• The study was a retrospective analysis of patients treated between May 2019 and December 2022

Current guideline recommendations on post-thrombolysis antiplatelet timing may warrant revision based on these findings.

• The optimal timing for initiating antiplatelet therapy after intravenous alteplase was described as 'unclear' prior to this study due to concerns about intracranial hemorrhage
• Authors suggest 'earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations'
• The study was retrospective in design, which limits causal inference