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)


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.


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.


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.


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.