Safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.

Objectives: To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.
Methods: Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale (NIHSS) score ≤3 and a platelet count <100×10 ⁹ /L were obtained from a multicenter register. Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded. Short-term safety outcomes were in-hospital bleeding events, while the long-term safety outcome was a 1-year all-cause death. The short-term neurological outcomes were evaluated by modified Rankin scale (mRS) score at discharge.
Results: A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled. Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge ( OR =1.657, 95% CI : 1.253-2.192, P <0.01) and did not increase the risk of intracranial hemorrhage ( OR =2.359, 95% CI : 0.301-18.503, P >0.05), compared with those without antiplatelet therapy. However, dual-antiplatelet therapy did not bring more neurological benefits ( OR =0.923, 95% CI : 0.690-1.234, P >0.05), but increased the risk of gastrointestinal bleeding ( OR =2.837, 95% CI : 1.311-6.136, P <0.01) compared with those with mono-antiplatelet therapy. For patients with platelet counts ≤75×10 ⁹ /L and >90×10 ⁹ /L, antiplatelet therapy significantly improved neurological functional outcomes (both P <0.05). For those with platelet counts (>75-90)×10 ⁹ /L, antiplatelet therapy resulted in a significant improvement of 1-year survival ( P <0.05). For patients even with concurrent coagulation abnormalities, mono-antiplatelet therapy did not increase the risk of various types of bleeding (all P >0.05) but improved neurological functional outcomes (all P <0.01). There was no significant difference in the occurrence of bleeding events, 1-year all-cause mortality risk, and neurological functional outcomes between aspirin and clopidogrel (all P >0.05).
Conclusions: For non-cardioembolic mild stroke patients with thrombocytopenia, antiplatelet therapy remains a reasonable choice. Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.