Timing matters: early antiplatelet therapy optimizes alteplase treatment in acute ischemic stroke
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background The optimal timing for initiating antiplatelet therapy (APT) after intravenous alteplase in acute ischemic stroke (AIS) remains unclear, due to concerns about intracranial hemorrhage. This study evaluated the safety and efficacy of early APT (≤24 h post-alteplase) versus standard APT (>24 h) in AIS patients.Methods We conducted a retrospective analysis of 154 AIS patients treated with intravenous alteplase between May 2019 and December 2022. Patients were stratified into early APT (E-APT, n = 77) and standard APT (S-APT, n = 77) groups. Neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge and at 3 months. Coagulation parameters and hemorrhagic events were monitored to evaluate safety.Results Baseline characteristics were comparable between groups. At 3 months, the E-APT group demonstrated significantly greater neurological improvement (ΔNIHSS: 4.31 ± 3.45 vs. 3.25 ± 3.49; p = 0.041) and better functional outcomes (mRS: 0.98 ± 1.12 vs. 1.35 ± 1.24; p = 0.030) than the S-APT group. Early APT was not associated with increased cerebral hemorrhage (0% vs. 2.6%, p = 0.155) or mortality (2.6% vs. 5.2%, p = 0.405). Spearman correlation confirmed that shorter intervals from alteplase to APT were associated with improved outcomes (ΔNIHSS: ρ = −0.28, p = 0.001; mRS: ρ = 0.24, p = 0.003). Subgroup analyses indicated that aspirin was the primary contributor to the observed benefits.Conclusions Initiating APT within 24 h after alteplase improves neurological and functional recovery in AIS without increasing hemorrhagic risk. These findings suggest that earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations.
Source: Annals of Medicine
Authors: Yonglei Gao, Yubin Wu, Wei Guo, Guoqing Wang
Institutions: Binzhou People's Hospital, Binzhou Medical University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,557
OpenAlex ID: W7140718567