Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
J Neurol Sci. 2023 Feb 15;445:120546. doi: 10.1016/j.jns.2023.120546. Epub 2023 Jan 6.
We examined outcome of acute ischemic stroke (AIS) with administration of antithrombotics within 24 h after intravenous low-dose alteplase.
Consecutive AIS patients who were treated with intravenous alteplase at 0.6 mg/kg from 2005 to 2021 were retrospectively included in our single-center registry. Patients were classified into two groups: those who received antithrombotics within 24 h after intravenous alteplase (early initiation group) and those who did not (control group). Safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH (sICH) within 36 h after onset, and death within 3 months. sICH was defined as any ICH with a ≥ 4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score or death within 36 h.
Of 1111 patients (women, 426; median age, 76 [interquartile range, 69-83] years; median NIHSS score, 11 [6-19]; cardioembolism, 580 [52.2%]), early initiation group comprised 58 patients (22; 72 [65-80] years; 7 [4-12]; 11 [19.0%]) and control group comprised 1053 patients (404; 77 [69-84] years; 11 [6-19]; 569 [54.1%]). No significant between-group differences were observed in the incidence of any ICH (17.2% vs. 21.6%; adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 0.57-2.44), sICH (0% vs. 0.9%, P = 1.00), or death within 3 months (5.2% vs. 6.7%; aOR, 1.23; 95% CI, 0.36-4.23).
Early initiation of antithrombotics after intravenous alteplase at 0.6 mg/kg did not increase the rate of sICH or death within 3 months and may be used with caution in patients with advanced neurological deterioration.
我们研究了在静脉注射低剂量阿替普酶后 24 小时内使用抗血栓药物治疗急性缺血性脑卒中（AIS）的结果。
连续纳入 2005 年至 2021 年期间接受 0.6mg/kg 静脉注射阿替普酶治疗的 AIS 患者，纳入本单中心登记研究。将患者分为两组：在静脉注射阿替普酶后 24 小时内使用抗血栓药物的患者（早期启动组）和未使用抗血栓药物的患者（对照组）。安全性结局为任何颅内出血（ICH）、发病后 36 小时内症状性 ICH（sICH）和 3 个月内死亡。sICH 定义为 NIHSS 评分增加≥4 分的任何 ICH 或 36 小时内死亡。
1111 例患者中（女性 426 例；中位年龄 76 岁[四分位距 69-83]；中位 NIHSS 评分 11 分[6-19]；心源性栓塞 580 例[52.2%]），早期启动组 58 例（22 例；72 岁[65-80]；7 分[4-12]；11 分[19.0%]），对照组 1053 例（404 例；77 岁[69-84]；11 分[6-19]；569 例[54.1%]）。两组任何 ICH（17.2%比 21.6%；调整后比值比[aOR]，1.18；95%置信区间[CI]，0.57-2.44）、sICH（0%比 0.9%，P=1.00）或 3 个月内死亡（5.2%比 6.7%；aOR，1.23；95%CI，0.36-4.23）的发生率无显著差异。
0.6mg/kg 静脉注射阿替普酶后早期使用抗血栓药物并未增加 sICH 或 3 个月内死亡的发生率，在神经功能恶化的患者中谨慎使用可能是合理的。
