Author Response: Safety and Efficacy of Dual Antiplatelet Pretreatment in Patients With Ischemic Stroke Treated With IV Thrombolysis: A Systematic Review and Meta-analysis

Abstract

We would like to thank Drs. Xu and Hu for their response on our recently published meta-analysis on the safety and efficacy of dual antiplatelet pretreatment in patients with ischemic stroke treated with intravenous thrombolysis.1 We would like to highlight that the 2 studies mentioned by Drs. Xu and Hu do not have overlapping patients2,3 because the University of Tennessee Health Science Center (UTHSC) does not participate in the SITS registry. Therefore, stroke patients included in the single center study from UTHSC2 cannot overlap with patients from the Safe Implementation of Thrombolysis in Stroke registry cohort.3 Therefore, there is no concern for overlapping patient data in our meta-analysis. Responding to Drs. Xu and Hu s second concern, we would like to note that both of these studies2,3 provide unadjusted (raw) and adjusted estimates (after propensity score matching) on the association between dual antiplatelet pretreatment and the risk of symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis. These unadjusted and adjusted estimates are included in figure 1A and figure 2A of our meta-analysis, respectively.1 Of interest to the readers of the journal, the lack of association between dual antiplatelet pretreatment with the risk of SICH after intravenous thrombolysis has very recently been confirmed by an independent publication from the Thrombolysis in Stroke Patients (TRISP) collaborators.4