Effect of preceding antiplatelet agents on ischemic stroke severity in patients with a history of stroke

Abstract Background: Antiplatelet agents are effective in secondary prevention of ischemic stroke and can reduce the severity of first-ever ischemic stroke. However, it remains controversial whether prophylactic administration of antiplatelet agents can reduce the severity of recurrent ischemic stroke. This study aimed to determine the effect of preceding antiplatelet treatment on ischemic stroke severity in patients with a prior history of stroke.Methods: From the prospective hospital registry of 1338 consecutive patients with ischemic stroke within 7 days of symptom onset, we identified patients with a prior history of stroke who were admitted due to cerebral thrombosis, which included large-artery atherosclerosis, small vessel occlusion, and branch atheromatous disease. Patients were categorized into 2 groups according to preceding medication: antiplatelet (AP) group and none (N) group. Those with preceding anticoagulant agents or unknown prior medication were excluded. Stroke severity (National Institutes of Health Stroke Scale: NIHSS) on admission was compared between the 2 groups.Results: A total of 88 patients were analyzed. Out of these, 66 were identified in the AP group (median age 78, male 71%), and 22 in the N group (median age 71, male 73%). The median NIHSS on admission was lower in the AP group than in the N group (3 vs 5, p=0.043). In multivariate analysis, preceding antiplatelet treatment was independently associated with mild stroke (NIHSS ≤4) on admission (odds ratio 5.77, 95% confidence interval 1.73-21.6, p=0.004).Conclusion: Preceding antiplatelet treatment in patients with a prior history of stroke may reduce the severity of subsequent cerebral thrombosis.