Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke.

Background: The risk of intracerebral hemorrhage in systemic thrombolysis for acute ischemic stroke after acetylsalicylic acid (ASA) pretreatment or with subsequent heparin is controversially discussed.

Methods: 300 consecutive stroke patients were treated with recombinant tissue-type plasminogen activator (rt-PA) in a prospective open study (92 pretreated with ASA, 202 ASA nonusers) with 3 months of follow-up. After thrombolysis, 122 patients received low-dose, 153 patients high-dose heparin.

Results: Logistic regression analysis showed no relationship of hemorrhagic complications within the first 48 h to ASA pretreatment (p = 0.15), or heparin application (p = 0.38), but dependency on stroke severity (NIHSS) at baseline (p = 0.01).

Conclusion: ASA pretreatment does not increase the risk of symptomatic bleeding after systemic thrombolysis with rt-PA, even if thrombolysis is followed by anticoagulation.