Abstract W P19: Large Single Center Experience of Safety of Parenteral Infusion and Maintenance of Antiplatelets in Patients with Acute Ischemic Stroke undergoing Mechanical Thrombectomy and Thrombolysis
Background and Objective: Lack of achieving complete recanalization in acute strokes using only IV thrombolysis has led to the evolution of a multimodal acute ischemic stroke paradigm which includes combination of intra-arterial tPA, mechanical thrombectomy and stenting. There is limited data on safety of administering intra-arterial and intra-venous antiplatelet agents within the acute stroke treatment paradigm to maintain target vessel recanalization.
Methods: Of the total patients with acute ischemic strokes presented between 2010-13 to our university affiliated comprehensive stroke center, patients that received IA and IV Eptifibatide were retrospectively classified into two groups: Group A underwent emergent intracranial stenting with IV and or IA r-tPa and/or mechanical thrombectomy. Group B underwent IV r-tPa/ IA r-tPa /IA Eptifibatide and/or mechanical thrombectomy with no intracranial stenting. Eptifibatide was administered intra-arterially as a 135-μg/kg single-dose bolus, and then continued on intravenous infusion of 0.5-μg/kg/min post-procedurally. Charts were reviewed for all patients to assess for complications including groin hematoma, asymptomatic and symptomatic hemorrhages, epistaxis and gross hematuria.
Results: Of the total of 2016 patients with ischemic strokes, 326 patients received acute stroke treatment and a total of 138 patients received IA and IV Eptifibatide. Group A with acute stenting (82 patients, mean age 68, 49% males [n=40]) and Group B without stenting (56 patients, mean age 73, 54% males [n=30]) received IV Eptifibatide infusion for a mean duration of 19 hours (range 0 to 364 hours). In Group A, 7.3% [n= 6] showed symptomatic ICH, 4.9% [n=4] asymptomatic ICH, 3.7% [n=3] groin hematomas, 2.4% [n=2] nose bleeds. In Group B, 7.1 % [n=4] had asymptomatic hemorrhages and 1.8% [n=1] showed gross hematuria.
Conclusion: The complications of IV and IA Eptifibatide are not significantly higher than those associated with the existing acute ischemic stroke treatment paradigm. Larger, multi-centered prospective trials are warranted to corroborate our findings.
Author Disclosures: J.F. Kirmani: None. M. Hussain: None. S. Mehta: None. J. Brar: None. H. Chahal: None. J. Ahmad: None. D. Korya: None. N. Khan: None. E. Karim: None. M. Moussavi: None.
- © 2015 by American Heart Association, Inc.