Low-Molecular-Weight Heparin or Dual Antiplatelet Therapy Is More Effective Than Aspirin Alone in Preventing Early Neurological Deterioration and Improving the 6-Month Outcome in Ischemic Stroke Patients

There is a lack of studies on anticoagulant plus antiplatelet therapy for acute ischemic stroke. The present study made a pilot effort to investigate the efficacy and safety of argatroban plus dual antiplatelet therapy (DAPT) in patients with acute posterior circulation ischemic stroke (PCIS). We retrospectively collected patients diagnosed with acute PCIS according to inclusion/exclusion criteria. According to treatment drugs, patients were divided into an argatroban plus DAPT group and a DAPT group. The primary efficacy end point was the proportion of early neurological deterioration (END). The primary safety outcome was symptomatic intracranial hemorrhage. All outcomes were compared between the 2 groups before and after propensity score matching (PSM). A total of 502 patients were enrolled in the study, including 35 patients with argatroban plus DAPT and 467 patients with DAPT. There was a higher National Institutes of Health Stroke Scale (NIHSS) score in the argatroban plus DAPT group than the DAPT group before PSM (3 vs 2, P = .017). Compared with the DAPT group, the argatroban plus DAPT group had no END (before PSM: 0% vs 6.2%, P = .250; after PSM: 0% vs 5.9%, P = .298). Argatroban plus DAPT yielded a significant decrease in the NIHSS score from baseline to 7 days after hospitalization, compared with that of the DAPT group before PSM ( P = .032), but not after PSM ( P = .369). No symptomatic intracranial hemorrhage was found in any patient. A short-term combination of argatroban with DAPT appears safe in acute minor PCIS.

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Puncture site bleeding complications in patients with Clopidogrel hyper-response

Romanian Neurosurgery ◽

10.33962/roneuro-2020-008 ◽

2020 ◽

pp. 58-65

Author(s):

Nedeljković Žarko ◽

Vukasinović Ivan ◽

Majstorović Branisalva ◽

Milosević Medenica Svetlana ◽

Milićević Mihailo ◽

...

Keyword(s):

Molecular Weight ◽

Antiplatelet Therapy ◽

Femoral Artery ◽

Low Molecular Weight Heparin ◽

Dual Antiplatelet Therapy ◽

Platelet Reactivity ◽

Thrombus Formation ◽

Bleeding Complications ◽

Low Molecular Weight ◽

Increased Risk

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.

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Prevention of Venous Thromboembolism, Recurrent Stroke, and Other Vascular Events After Acute Ischemic Stroke: The Role of Low-Molecular-Weight Heparin and Antiplatelet Therapy

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2006.06.001 ◽

2006 ◽

Vol 15 (6) ◽

pp. 250-259 ◽

Cited By ~ 6

Author(s):

David G. Sherman

Keyword(s):

Molecular Weight ◽

Ischemic Stroke ◽

Venous Thromboembolism ◽

Acute Ischemic Stroke ◽

Antiplatelet Therapy ◽

Low Molecular Weight Heparin ◽

Recurrent Stroke ◽

Low Molecular Weight ◽

Vascular Events

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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Low Molecular Weight Heparin and the Treatment of Ischemic Stroke

Annals of the New York Academy of Sciences ◽

10.1111/j.1749-6632.2001.tb03634.x ◽

2006 ◽

Vol 939 (1) ◽

pp. 268-270 ◽

Cited By ~ 2

Author(s):

SARAN JONAS ◽

DAVID QUARTERMAIN

Keyword(s):

Molecular Weight ◽

Ischemic Stroke ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight

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Hypoperfusion in lenticulostriate arteries territory related to unexplained early neurological deterioration after intravenous thrombolysis

International Journal of Stroke ◽

10.1177/1747493019830595 ◽

2019 ◽

Vol 14 (3) ◽

pp. 306-309 ◽

Cited By ~ 2

Author(s):

Ying Zhou ◽

Wansi Zhong ◽

Anli Wang ◽

Wanyun Huang ◽

Shenqiang Yan ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Intravenous Thrombolysis ◽

Neurological Deterioration ◽

Terminal Branch ◽

Stroke Patients ◽

Lenticulostriate Arteries ◽

Early Neurological Deterioration

Background Early neurological deterioration occurs in approximately 10% acute ischemic stroke patients after thrombolysis. Over half of the early neurological deterioration occurred without known causes and is called unexplained early neurological deterioration. Aims We aimed to explore the development of early neurological deterioration at 24 h after thrombolysis, and whether it could be predicted by the presence of baseline hypoperfusion in lenticulostriate arteries territory in acute ischemic stroke patients. Methods We retrospectively reviewed our prospectively collected database of acute ischemic stroke patients in the unilateral middle cerebral artery territory who had baseline perfusion image and received thrombolysis. Unexplained early neurological deterioration was defined as ≥ 2 points increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h, without known causes. Hypoperfusion lesions in different territories were identified on perfusion maps. Results A total of 306 patients were included in analysis. Patients with pure lenticulostriate arteries hypoperfusion (defined as the presence of hypoperfusion in lenticulostriate artery territory, but not in middle cerebral artery terminal branch territory) were more likely to have unexplained early neurological deterioration than others (27.6% vs. 6.1%; OR, 5.974; p = 0.001), after adjusting for age, baseline NIHSS and onset to treatment time. Conclusions Patients presenting hypoperfusion in pure lenticulostriate arteries territory were easier to experience unexplained early neurological deterioration.

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