Negative interaction of aspirin and streptokinase in acute ischemic stroke: Further analysis of the Multicenter Acute Stroke Trial-Italy

Background: Thrombolytic therapy improves the functional outcome in acute i schemic stroke, but the risk of death and cerebral hemorrhage remains high. Aspirin given together with a thrombolytic agent may worsen the risk-to-be nefit ratio. We performed a further Multicenter Acute Stroke Trial-Italy (M AST-I) which is the only randomized, controlled trial that has tested the e ffect of this combination to evaluate the risk of aspirin use plus streptok inase, Patients and Methods: We made a post hoc analysis of the MAST-I resu lts comparing streptokinase plus aspirin (156 patients) with streptokinase alone (157 patients). We evaluated the risk of death and cerebral hemorrhag e, Results: The combined regimen significantly increased early case fatalit y from day 3-10 (53 vs. 30; OR 2.1; CI 1.2-3.6). The death excess was solel y due to treatments and was not explained by the main prognostic predictors (multifactorial analysis). The cause of death in the combination group was mainly cerebral (42 vs. 24; OR 2.0; CI 1.3-3.7) and associated with hemorr hagic transformation (22 vs. 11; OR 2.2; CI 1.0-5.0), The rate of stroke re occurrence was not increased in patients treated with streptokinase alone ( 15 vs. 11; OR 1.4; CI 0.6-3.4). Conclusions: Stroke patients treated with s treptokinase plus aspirin have an increased risk of early death, probably d ue to cerebral hemorrhagic complications. Whenever thrombolytics are chosen for acute stroke treatment, aspirin and other antiplatelet agents should b e avoided. Copyright (C) 2000 S. Karger AG, Basel.