Safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia

• Published in: Zhejiang da xue xue bao. Journal of Zhejiang University. Medical sciences. Yi xue ban Vol. 53; no. 2; pp. 175 - 183
• Main Authors: XU, Dongjuan, ZHOU, Huan, HU, Mengmeng, SHEN, Yilei, LI, Hongfei, WEI, Lianyan, XU, Jing, JIANG, Zhuangzhuang, SHAO, Xiaoli, XI, Zhenhua, HE, Songbin, LOU, Min, KE, Shaofa
• Format: Journal Article
• Language: English
• Published: China 25.04.2024
• Subjects: Aged; Female; Humans; Intracranial Hemorrhages - chemically induced; Ischemic Stroke - complications; Ischemic Stroke - drug therapy; Male; Middle Aged; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Count; Stroke - complications; Thrombocytopenia - complications; Thrombocytopenia - drug therapy; Antiplatelet therapy; Thrombocytopenia; Non-cardioembolic stroke; Retrospective study; Safety
• ISSN: 1008-9292
• DOI: 10.3724/zdxbyxb-2023-0423

To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia. Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale (NIHSS) score ≤3 and a platelet count <100×10 /L were obtained from a multicenter register. Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded. Short-term safety outcomes were in-hospital bleeding events, while the long-term safety outcome was a 1-year all-cause death. The short-term neurological outcomes were evaluated by modified Rankin scale (mRS) score at discharge. A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled. Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge ( =1.657, 95% : 1.253-2.192, <0.01) and did not increase the risk of intracranial hemorrhage ( =2.359, 95% : 0.301-18.503, >0.05), compared with those without antiplatelet therapy. However, dual-antiplatelet therapy did not bring more neurological benefits ( =0.923, 95% : 0.690-1.234, >0.05), but increased the risk of gastrointestinal bleeding ( =2.837, 95% : 1.311-6.136, <0.01) compared with those with mono-antiplatelet therapy. For patients with platelet counts ≤75×10 /L and >90×10 /L, antiplatelet therapy significantly improved neurological functional outcomes (both <0.05). For those with platelet counts (>75-90)×10 /L, antiplatelet therapy resulted in a significant improvement of 1-year survival ( <0.05). For patients even with concurrent coagulation abnormalities, mono-antiplatelet therapy did not increase the risk of various types of bleeding (all >0.05) but improved neurological functional outcomes (all <0.01). There was no significant difference in the occurrence of bleeding events, 1-year all-cause mortality risk, and neurological functional outcomes between aspirin and clopidogrel (all >0.05). For non-cardioembolic mild stroke patients with thrombocytopenia, antiplatelet therapy remains a reasonable choice. Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.