Cerebrovascular Diseases
Original Paper
Antiplatelet Therapy in Combination with rt-PA Thrombolysis in Ischemic Stroke (ARTIS): Rationale and Design of a Randomized Controlled TrialZinkstok S.M.a · Vermeulen M.a · Stam J.a · de Haan R.J.b · Roos Y.B.aaDepartment of Neurology and bClinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
|
|
Log in to MyKarger to check if you already have access to this content.
KAB
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price.
Article / Publication Details
Received: April 14, 2009
Accepted: August 25, 2009
Published online: November 10, 2009
Issue release date: December 2009
Number of Print Pages: 3
Number of Figures: 0
Number of Tables: 0
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
Background: Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is currently the only approved acute therapy for ischemic stroke. After rt-PA-induced recanalization, reocclusion is observed in 20–34%, probably caused by platelet activation. In acute myocardial infarction, the combination of thrombolytic and antiplatelet therapy leads to a better outcome compared to thrombolytic treatment alone. In patients with acute ischemic stroke, several studies showed that those on antiplatelet treatment prior to rt-PA had an equal or even better outcome compared to patients without prior use of antiplatelet therapy, despite an increased risk of bleeding. Methods: We present the protocol of a multicenter randomized clinical trial (n = 800) investigating the effects of immediate addition of aspirin to rt-PA on poor outcome (modified Rankin score >2) in ischemic stroke patients. Conclusion: This study will answer the question whether the combination of rt-PA and antiplatelet therapy improves the functional outcome in ischemic stroke patients.
© 2009 S. Karger AG, Basel
Related Articles:
References
- Molina CA, Montaner J, Abilleira S, Arenillas JF, Ribo M, Huertas R, Romero F, Alvarez-Sabín J: Time course of tissue plasminogen activator-induced recanalization in acute cardioembolic stroke: a case-control study. Stroke 2001;32:2821–2827.
- Rha JH, Saver JL: The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007;38:967–973.
- Alexandrov AV, Grotta JC: Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology 2002;59:862–867.
- Rubiera M, Alvarez-Sabín J, Ribo M, Montaner J, Santamarina E, Arenillas JF, Huertas R, Delgado P, Purroy F, Molina CA: Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke. Stroke 2005;36:1452–1456.
- Saqqur M, Molina CA, Salam A, Siddiqui M, Ribo M, Uchino K, Calleja S, Garami Z, Khan K, Akhtar N, O’Rourke F, Shuaib A, Demchuk AM, Alexandrov AV: Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. Stroke 2007;38:69–74.
- ISIS-2 (Second International Study of Infarct Survival) Collaborative Group: Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349–360.
- Multicentre Acute Stroke Trial – Italy (MAST-I) Group: Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 1995;346:1509–1514.
- National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.
- Grotta JC, Welch KM, Fagan SC, Lu M, Frankel MR, Brott T, Levine SR, Lyden PD: Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial. Stroke 2001;32:661–668.
-
Diedler J, Ahmed N, Sykora M, Uyttenboogaart M, Overgaard K, Luijckx GJ, Soinne L, Lees KR, Wahlgren N, Ringleb AP: Safety of intravenous thrombolysis for acute ischaemic stroke in patients with antiplatelet therapy at stroke onset (abstract). Cerebrovasc Dis 2009;27(suppl 6):16.
-
Rodrigues AM, Mariz JA, Pinho JD, Maré R, Ferreira C, Fontes J: Antiplatelet therapy before endovenous thrombolysis in acute stroke (abstract). Cerebrovasc Dis 2009;27(suppl 6):80.
- Uyttenboogaart M, Koch MW, Koopman K, Vroomen PC, Keyser de KJ, Luijckx GJ: Safety of antiplatelet therapy prior to intravenous thrombolysis in acute ischemic stroke. Arch Neurol 2008;65:607–611.
- Bravo Y, Marti-Fabregas J, Cocho D, Rodirguez-Yanez M, Castellanos M, Ossa de la PM, Roquer J, Obach V, Maestre J, Marti-Vilalta JM: Influence of antiplatelet pre-treatment on the risk of symptomatic intracranial haemorrhage after intravenous thrombolysis. Cerebrovasc Dis 2008;26:126–133.
- Schmülling S, Rudolf J, Strotmann-Tack T, Grond M, Schneweiss S, Sobesky J, Thiel A, Heiss WD: Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke. Cerebrovasc Dis 2003;16:183–190.
- Sobesky J, Frackowiak M, Zaro Weber O, Hahn M, Moller-Hartmann W, Rudolf J, Neveling M, Grond M, Schmülling S, Jacobs A, Heiss WD: The Cologne stroke experience: safety and outcome in 450 patients treated with intravenous thrombolysis. Cerebrovasc Dis 2007;24:56–65.
- Tanne D, Kasner SE, Demchuk AM, Koren-Morag N, Hanson S, Grond M, Levine SR: Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 2002;105:1679–1685.
Article / Publication Details
Received: April 14, 2009
Accepted: August 25, 2009
Published online: November 10, 2009
Issue release date: December 2009
Number of Print Pages: 3
Number of Figures: 0
Number of Tables: 0
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Get Permission
PubMed ID
