Wu Chuanjie, Wu Di, Chen Jian, Li Chuanhui, Ji Xunming
1Department of neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
2China-America Institute of Neuroscience, Xuanwu Hospital Capital Medical University, Beijing, China.
Aging Dis. 2018 Apr 1;9(2):309-316. doi: 10.14336/AD.2017.0406. eCollection 2018 Apr.
Acute ischemic stroke continues to be a very severe disorder that has significant impact on human health. Its treatment options are limited and alteplase remains the only American Food and Drug Administration-approved drug for patients with acute ischemic stroke. Furthermore, intravenous thrombolysis remains substantially underutilized, because it has rigorous indications and contraindications. Most patients simply do not meet these criteria and cannot receive thrombolytic treatment. Guidelines in many countries currently include a history of stroke within months as one of the exclusion criteria for intravenous thrombolysis. Although this is based on previous data, it lacks strong evidentiary support. Several recent studies suggested that intravenous thrombolysis may be beneficial for this patient population. We reviewed relevant publications of intravenous thrombolysis or repeated intravenous thrombolysis in patients with a history of stroke in the past 3 months. We found that intravenous thrombolysis in these patients is not as hazardous as previously believed. Among patients with relatively small infarctions and a good prognosis, intravenous thrombolysis may be a good treatment option. We hope that more research will be carried out on this topic to reexamine the criteria for intravenous thrombolysis to allow more patients to benefit from treatment.
急性缺血性中风仍然是一种非常严重的疾病，对人类健康有重大影响。其治疗选择有限，阿替普酶仍然是美国食品药品监督管理局批准的唯一用于急性缺血性中风患者的药物。此外，静脉溶栓的使用率仍然很低，因为它有严格的适应证和禁忌证。大多数患者根本不符合这些标准，无法接受溶栓治疗。目前许多国家的指南将数月内有中风病史作为静脉溶栓的排除标准之一。尽管这是基于以前的数据，但缺乏有力的证据支持。最近的几项研究表明，静脉溶栓可能对这一患者群体有益。我们回顾了过去3个月内有中风病史患者的静脉溶栓或重复静脉溶栓的相关出版物。我们发现，这些患者进行静脉溶栓并不像以前认为的那样危险。在梗死相对较小且预后良好的患者中，静脉溶栓可能是一个不错的治疗选择。我们希望能就这一主题开展更多研究，重新审视静脉溶栓的标准，让更多患者从治疗中受益。
