A team at Seoul National University Bundang Hospital has recently updated the standard stroke guideline used by the American Heart Association (AHA) and American Stroke Association (ASA) with its new research.

The research, led by Professor Kim Beom-joon, confirmed that the risk of antithrombotic therapy within first 24-hours after treatment with intravenous (IV) alteplase, with or without endoscopic third ventriculostomy, on acute ischemic stroke victim is uncertain.

Until now, the principle was not to administer additional antithrombotic agents within 24-hours after IV alteplase as it may increase the risk of hemorrhaging. However, the guideline was part of a principal for conducting large-scale clinical trials conducted in the early 1990s and not on an actual study to confirm the increase in bleeding risk when administering oral anticoagulants within 24 hours.

Also, many theorized that antithrombotic agents, if applied early, can prevent the possibility of early recurrence of ischemic strokes.

Based on the theory, the research team conducted a clinical study of 712 patients who underwent revascularization treatment at the hospital from 2007 to 2015.

The study divided the patients into two groups based on the time of oral antithrombotic therapy after the revascularization treatment. The team placed 456 patients in the early treatment group and 256 patients in the standard treatment group.

Hemorrhagic complications occurred in 26.8 percent of the patients in the early treatment group, and 34.4 percent of the standard treatment group. The results indicated that the early treatment reduced the possibility of cerebral hemorrhage by 44 percent in the early treatment group compared to the standard treatment group.

Although the study was not a randomized clinical trial and did not prove that antithrombotic treatment reduces the incidence of bleeding, it confirmed that initial doses of antithrombotic therapy do not increase hemorrhaging.

“The revision of an international guideline by research data conducted by domestic researchers in Korea indicates that the level of stroke care and research reliability in Korea is at a global level,” Professor Kim said.

The research of the study was announced at the International Stroke Conference organized AHA and ASA in January. The AHA/ASA 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke is based on the latest research findings.