Clinical Outcomes of Early versus Late Initiation of Aspirin in the Middle Cerebral Artery Stenosis in Acute Stroke
Article Sidebar
Main Article Content
Abstract
Background: The optimal time to initiate oral antiplatelet after middle cerebral artery (MCA) stenosis in acute ischemic stroke is still unclear regarding high risk of cerebral edema or hemorrhagic transformation. Early initiation may increase the risk of intracranial hemorrhage (ICH) while delay initiation may enhance the risk of progressive ischemic stroke and recurrent ischemic events.
Objectives: To investigate the clinical outcomes of early or late aspirin initiation in MCA stenosis in acute stroke.
Methods: This retrospective cohort analysis data from 1st September 2023 to 31st August 2024. Patients were classified into the Early (<48h) and Late groups (>48h), based on last known well to initiate aspirin time.
Results: 52 patients of MCA stenosis were devided into 2 groups, the Early group 32 patients and the Late group 20 patients. Hemorrhagic transformation, extracranial bleed, cerebral edema and mortality rate in the Early group were 0%, 0%, 0% and 3.1%, respectively. Fully recovered at 90 days in the Early group was 12.5%. The Late group showed hemorrhagic transformation, extracranial bleed, cerebral edema and mortality rate were 25%, 5%, 10% and 20%, respectively. Fully recovered at 90 days in the Late group was 0%.
Conclusion: Hemorrhagic transformation, extracranial bleed, cerebral edema and mortality rate in the Early group were lower than the Late group. Also the Early group had fully recovered at 90 days more than the Late group.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
ประเทศ ม. การสูญเสียปีสุขภาวะ รายงานภาระโรค และการ บาดเจ็บของประชากรไทย พ.ศ. 2557. มูลนิธิเพื่อการพัฒนานโยบายสุขภาพระหว่าง ประเทศ สำนักงานพัฒนานโยบายสุขภาพระหว่าง ประเทศ; 2017.
Ding Q, Liu S, Yao Y, Liu H, Cai T, Han L. Global, regional, and national burden of ischemic stroke, 1990–2019. Neurology. 2022;98(3):e279-e90.
Amarenco P, Bogousslavsky J, Caplan L, Donnan G, Hennerici M. Classification of stroke subtypes. Cerebrovascular diseases. 2009;27(5):493-501.
Norrving B. Classification of stroke subtypes. Stroke: Karger Publishers; 2009. p. 50-63.
Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. stroke. 1993;24(1):35-41.
Suwanwela NC. Stroke epidemiology in Thailand. Journal of stroke. 2014;16(1):1.
Chen Z-M. CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. The Lancet. 1997;349(9066):1641-9.
Group ISTC. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. The Lancet. 1997;349(9065):1569-81.
Heinsius T, Bogousslavsky J, Van Melle G. Large infarcts in the middle cerebral artery territory Etiology and outcome patterns. Neurology. 1998;50(2):341-50.
Liebeskind DS, Jüttler E, Shapovalov Y, Yegin A, Landen J, Jauch EC. Cerebral edema associated with large hemispheric infarction: implications for diagnosis and treatment. Stroke. 2019;50(9):2619-25.
Martí-Fàbregas J, Cocho D, Martí-Vilalta J-L, Gich I, Belvís R, Bravo Y, et al. Aspirin or anticoagulants in stenosis of the middle cerebral artery: a randomized trial. Cerebrovascular Diseases. 2006;22(2-3):162-9.
