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No Danger From Aspirin and Clot-Busting Drug in Stroke Patients

tPA doesn’t increase brain bleeds (Mar. 13)

Millions of Americans take aspirin or other drugs every day to reduce their risk of heart attacks or other problems caused by blood clots. But when one of them suffers a stroke caused by a clot in their brain, some emergency teams might hesitate to administer tissue plasminogen activator (tPA), a powerful clot-busting drug, for fear that the combination of drugs might cause dangerous brain bleeding.

Now, a new study conducted at the University of Michigan suggests that this fear may be unfounded, at least for most patients taking common clot-preventing therapies.

The study was based on data from 830 stroke patients who received tPA at 28 Michigan hospitals. Just under half of the patients were taking aspirin or clopidogrel (Plavix, Bristol-Myers Squibb) before they had their strokes.

After adjusting for the patients’ other characteristics, the researchers found no significant difference in the rate of hemorrhages seen on the patients’ brain scans — even low-level bleeding that didn’t cause symptoms.

According to the authors, the results — published in Academic Emergency Medicine — should help reassure emergency physicians and patients alike that tPA is safe to use even in patients who have been taking aspirin or clopidogrel.

The study did not include patients taking more potent blood thinners, such as warfarin, heparin, dabigatran (Pradaxa, Boehringer Ingelheim), or rivaroxaban (Xarelto, Janssen). The authors caution that the potential use of tPA in patients taking these drugs needs more study.

“In light of the long-term benefit that patients receive from antiplatelet therapy, the small increase in risk of intracranial hemorrhage after tPA treatment should not be a game-changer for emergency physicians,” said lead author William Meurer, MD, MS. “This study from a broad range of hospitals provides solid evidence based on real-world use of tPA that physicians should not alter their decision making based on aspirin or clopidogrel use when treating stroke patients with tPA.”

Sources: University of Michigan; March 13, 2013; and Academic Emergency Medicine; February 13, 2013.

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