1209. Safety of Antiplatelet Therapy within 24 Hours of IV-tPA: Lessons from the Treatment of Patients Requiring Combined Stenting and Thrombectomy for Acute Stroke

Authors: Yasmeen Elsawaf; Robert Rennert, MD; David Santiago-Dieppa, MD; Jeffrey Steinberg, MD; Arvin Wali, MD; Scott Olson, MD; J Pannell, MD; Alexander Khalessi (Orlando, FL)

Introduction: Although current stroke guidelines state that antiplatelet therapies be started 24 hours after IV-tPA administration, select patients with luminal irregularities after thrombectomy may benefit from earlier administration of antiplatelet agents. We explore the safety of antiplatelet administration within 24 hours of IV-tPA by studying a subset of patients requiring dual antiplatelets after combined stenting and thrombectomy for acute stroke. Methods: Retrospective review of a single-institution prospective database was conducted to identify patients who underwent mechanical thrombectomy for acute strokes with concomitant proximal high-grade stenoses or arterial dissections requiring concurrent stent placement and administration of dual antiplatelet agents within 24 hours of IV-tPA administration between June 2015 and April 2018. Admission NIHSS score, ICH incidence, and modified Rankin Scale score upon discharge and follow up were recorded. Results: Seven patients were loaded with dual antiplatelet agents within 24 hours of IV-tPA following thrombectomy of the basilar artery (n=1), middle cerebral artery (n=5), internal carotid artery (n=2), or anterior cerebral artery (n=1), with concomitant stent deployment in the ICA (n=6) or vertebrobasilar junction (n=1). Median NIHSS score prior to endovascular intervention was 14 (range: 12 to 20). 0/7 patients experienced post-procedure ICH. Median modified Rankin Scale score on discharge and 30-day follow up was 3 (range:1 to 6) and 2 (range: 0 to 2), respectively. Conclusion: Dual antiplatelet loading within 24 hours of IV-tPA administration did not result in ICH in this patient cohort. The safety and efficacy of standard or low dose anti-platelets after mechanical thrombectomy and within 24 hours of IV-tPA administration warrants future study.