Previous Antiplatelet Therapy and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion Treated With Direct Endovascular Therapy

BACKGROUND AND OBJECTIVES: Previous antiplatelet therapy (APT) may influence outcomes in patients undergoing direct endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke, but evidence on clinical benefits and safety is limited and inconsistent. We aimed to evaluate the effects of previous APT on the outcomes of direct EVT. METHODS: We conducted a retrospective analysis of consecutive patients treated at 20 high-volume stroke centers across 9 European countries and Israel (EVA-TRISP registry, 2015-2023). We included adults with anterior circulation LVO strokes, without previous use of IV thrombolysis (IVT) or anticoagulants. We compared outcomes of direct EVT patients stratified by previous APT regimen, using propensity score matching based on medical history and multilevel models to address confounders. The primary outcome was the 90-day modified Rankin Scale (mRS) score. The secondary efficacy outcomes were 90-day independence and the rate of successful reperfusion. The secondary safety outcomes were the rate of symptomatic intracranial hemorrhage (sICH) and mortality. RESULTS: = 0.743). DISCUSSION: In patients with anterior circulation LVO stroke treated with direct EVT and no previous anticoagulation, pretreatment with any APT was independently linked to better 90-day functional outcomes and higher independence, without increasing sICH risk. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, in patients with anterior circulation LVO stroke treated with direct EVT, previous APT is associated with better 90-day functional outcomes compared with no previous APT.